- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $95.50 / $154.88
| Facility | | $42.66 | $95.50 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $33.11
| Professional | | $20.89 | $28.18 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $120.23
| Facility | | $33.88 | $53.70 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $50.12
| Professional | | $31.62 | $45.71 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $66.07
| Professional | | $26.30 | $40.74 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $67.61 / $125.89
| Facility | | $28.84 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $41.69
| Professional | | $20.89 | $28.18 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $44.67 / $56.23
| Facility | | $25.70 | $44.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $56.23
| Professional | | $24.55 | $44.67 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $41.69
| Facility | | $20.89 | $35.48 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $20.89 / $54.95
| Professional | | $14.79 | $20.89 | $54.95 |