- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $512.86
| Facility | | $22.91 | $25.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $28.84
| Professional | | $16.98 | $23.99 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $54.95
| Professional | | $30.20 | $36.31 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $1,122.02 / $2,187.76
| Facility | | $66.07 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $58.88
| Professional | | $23.99 | $31.62 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $141.25
| Facility | | $43.65 | $47.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $70.79 / $112.20
| Professional | | $33.11 | $70.79 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $46.77
| Professional | | $21.88 | $26.92 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $199.53 / $199.53
| Professional | | $173.78 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $44.67
| Facility | | $21.88 | $30.20 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $114.82
| Professional | | $24.55 | $33.11 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $6,025.60 / $18,620.87
| Facility | | $1,905.46 | $6,025.60 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $54.95
| Professional | | $19.50 | $27.54 | $54.95 |