- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $69.18 / $72.44
| Facility | | $38.90 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $52.48
| Professional | | $30.20 | $36.31 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $77.62 / $158.49
| Facility | | $74.13 | $77.62 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $95.50
| Professional | | $35.48 | $43.65 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $83.18
| Facility | | $34.67 | $58.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $93.33
| Professional | | $45.71 | $63.10 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $45.71
| Facility | | $43.65 | $43.65 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $43.65
| Professional | | $31.62 | $31.62 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $43.65
| Professional | | $31.62 | $31.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $63.10
| Professional | | $31.62 | $44.67 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $154.88
| Professional | | $70.79 | $83.18 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $57.54 / $81.28
| Facility | | $27.54 | $57.54 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $53.70
| Professional | | $23.99 | $34.67 | $53.70 |