- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $4,365.16
| Facility | | $52.48 | $63.10 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $77.62
| Professional | | $25.12 | $36.31 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,148.15 / $2,344.23
| Facility | | $851.14 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $72.44
| Professional | | $38.02 | $54.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $83.18
| Professional | | $38.02 | $57.54 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $1,230.27
| Facility | | $38.02 | $66.07 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $436.52
| Professional | | $36.31 | $63.10 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $45.71
| Professional | | $15.85 | $19.95 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $57.54
| Facility | | $35.48 | $53.70 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $81.28
| Professional | | $38.02 | $60.26 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,202.26 / $2,344.23
| Facility | | $794.33 | $1,202.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $75.86
| Professional | | $38.02 | $54.95 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,513.56 / $3,019.95
| Facility | | $407.38 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $79.43
| Professional | | $29.51 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $48.98
| Professional | | $25.70 | $33.11 | $48.98 |