- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $47.86 / $53.70
| Facility | | $46.77 | $47.86 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $58.88
| Professional | | $28.84 | $40.74 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $87.10
| Facility | | $46.77 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $114.82
| Professional | | $46.77 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $93.33 / $102.33
| Professional | | $66.07 | $93.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $354.81
| Facility | | $48.98 | $89.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $125.89
| Professional | | $32.36 | $46.77 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $100.00
| Professional | | $85.11 | $89.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $128.82
| Professional | | $75.86 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $169.82
| Professional | | $79.43 | $104.71 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $79.43 / $173.78
| Facility | | $25.12 | $79.43 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $100.00
| Professional | | $32.36 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $74.13
| Professional | | $58.88 | $74.13 | $74.13 |