- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $83.18 / $141.25
| Facility | | $33.88 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $97.72
| Professional | | $20.89 | $28.84 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $5,011.87
| Facility | | $100.00 | $134.90 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $34.67 / $58.88
| Professional | | $33.88 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $74.13
| Facility | | $21.88 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $45.71
| Professional | | $12.88 | $17.78 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $50.12
| Professional | | $24.55 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $61.66
| Professional | | $26.30 | $38.02 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $50.12 / $208.93
| Facility | | $19.50 | $50.12 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $60.26
| Professional | | $39.81 | $39.81 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.88 / $43.65
| Professional | | $29.51 | $33.88 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $54.95 / $63.10
| Facility | | $26.30 | $54.95 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $89.13
| Professional | | $20.89 | $28.84 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $57.54 / $112.20
| Professional | | $46.77 | $57.54 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $70.79 / $104.71
| Facility | | $3.89 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $46.77 / $104.71
| Professional | | $3.89 | $46.77 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $16.22
| Facility | | $11.22 | $11.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $33.88 / $54.95
| Professional | | $18.62 | $33.88 | $54.95 |