- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $131.83
| Facility | | $40.74 | $50.12 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $91.20
| Professional | | $40.74 | $50.12 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $112.20
| Facility | | $104.71 | $104.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $117.49
| Professional | | $56.23 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $72.44
| Professional | | $53.70 | $53.70 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $67.61
| Facility | | $44.67 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $67.61
| Professional | | $50.12 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $147.91
| Professional | | $77.62 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $102.33
| Professional | | $52.48 | $69.18 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $120.23
| Facility | | $41.69 | $67.61 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $131.83
| Professional | | $38.02 | $56.23 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $302.00
| Facility | | $56.23 | $85.11 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $302.00
| Professional | | $56.23 | $85.11 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $104.71
| Facility | | $31.62 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $51.29 / $83.18
| Professional | | $46.77 | $51.29 | $83.18 |