- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $85.11 / $144.54
| Facility | | $43.65 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $109.65
| Professional | | $32.36 | $40.74 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $112.20
| Facility | | $43.65 | $43.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $95.50
| Professional | | $21.38 | $21.38 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $43.65
| Facility | | $26.30 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $43.65
| Professional | | $31.62 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $93.33 / $158.49
| Facility | | $42.66 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $61.66 / $208.93
| Professional | | $29.51 | $61.66 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $120.23
| Facility | | $28.84 | $50.12 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $83.18
| Professional | | $30.90 | $43.65 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $43.65 / $79.43
| Professional | | $41.69 | $43.65 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $151.36
| Facility | | $30.90 | $34.67 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $50,118.72
| Facility | | $52.48 | $83.18 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $56.23
| Professional | | $43.65 | $43.65 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $52.48 / $70.79
| Facility | | $43.65 | $52.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $37.15 / $100.00
| Professional | | $18.20 | $37.15 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $52.48
| Facility | | $37.15 | $43.65 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $104.71
| Professional | | $37.15 | $43.65 | $104.71 |