- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $131.83 / $891.25
| Facility | | $41.69 | $131.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $95.50
| Professional | | $33.88 | $39.81 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $346.74 / $5,011.87
| Facility | | $257.04 | $346.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $48.98
| Professional | | $38.02 | $38.02 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $74.13 / $165.96
| Facility | | $35.48 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $63.10 / $117.49
| Professional | | $28.84 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $70.79
| Professional | | $22.91 | $28.84 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $85.11
| Professional | | $48.98 | $54.95 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $302.00 / $446.68
| Facility | | $97.72 | $302.00 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $75.86 / $165.96
| Facility | | $39.81 | $75.86 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $61.66
| Professional | | $33.88 | $39.81 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $70.79
| Facility | | $48.98 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $575.44
| Professional | | $48.98 | $70.79 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $58.88
| Facility | | $28.84 | $48.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $85.11
| Professional | | $20.42 | $32.36 | $85.11 |