- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $45.71 / $52.48
| Professional | | $23.99 | $45.71 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $70.79
| Professional | | $60.26 | $60.26 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $275.42
| Facility | | $169.82 | $199.53 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $93.33 / $123.03
| Professional | | $26.92 | $93.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $53.70 / $63.10
| Facility | | $46.77 | $53.70 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $97.72 / $125.89
| Professional | | $57.54 | $97.72 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $100.00
| Facility | | $46.77 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $58.88
| Professional | | $21.38 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $70.79
| Professional | | $32.36 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $100.00
| Professional | | $47.86 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $162.18
| Professional | | $60.26 | $97.72 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $295.12
| Facility | | $128.82 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $288.40 / $346.74
| Professional | | $26.30 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $69.18 / $100.00
| Professional | | $21.38 | $69.18 | $100.00 |