- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $162.18
| Facility | | $53.70 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $97.72
| Professional | | $25.12 | $44.67 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $138.04
| Facility | | $53.70 | $53.70 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $102.33
| Professional | | $21.38 | $21.38 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $53.70
| Facility | | $32.36 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $53.70
| Professional | | $38.90 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $134.90 / $380.19
| Facility | | $52.48 | $134.90 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $63.10 / $257.04
| Professional | | $31.62 | $63.10 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $53.70 / $147.91
| Facility | | $21.88 | $53.70 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $102.33
| Professional | | $37.15 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $95.50
| Professional | | $41.69 | $51.29 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $100.00 / $50,118.72
| Facility | | $43.65 | $100.00 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $53.70 / $67.61
| Facility | | $47.86 | $53.70 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $44.67 / $120.23
| Professional | | $22.39 | $44.67 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $61.66 / $128.82
| Facility | | $30.20 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $141.25
| Professional | | $45.71 | $53.70 | $141.25 |