- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $50.12 / $57.54
| Facility | | $46.77 | $50.12 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $95.50
| Professional | | $43.65 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $102.33
| Professional | | $72.44 | $79.43 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $112.20
| Professional | | $83.18 | $104.71 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $158.49
| Facility | | $63.10 | $63.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $63.10
| Professional | | $45.71 | $45.71 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $54.95
| Facility | | $38.02 | $38.02 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $112.20
| Professional | | $48.98 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $64.57
| Professional | | $33.88 | $52.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $120.23
| Facility | | $33.88 | $46.77 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $66.07
| Professional | | $40.74 | $52.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $112.20
| Professional | | $52.48 | $52.48 | $112.20 |