- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $53.70 / $173.78
| Facility | | $52.48 | $53.70 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $380.19
| Professional | | $38.90 | $52.48 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $181.97 / $218.78
| Professional | | $69.18 | $181.97 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $95.50
| Facility | | $53.70 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $70.79 / $100.00
| Professional | | $66.07 | $70.79 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $91.20
| Facility | | $70.79 | $87.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $102.33
| Professional | | $89.13 | $89.13 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $114.82
| Facility | | $52.48 | $77.62 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $79.43 / $95.50
| Professional | | $44.67 | $79.43 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $141.25 / $354.81
| Facility | | $74.13 | $141.25 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $100.00 / $100.00
| Professional | | $91.20 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $134.90
| Facility | | $31.62 | $52.48 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $40.74 / $77.62
| Professional | | $36.31 | $40.74 | $77.62 |