- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $66.07 / $109.65
| Facility | | $41.69 | $66.07 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $75.86
| Professional | | $33.11 | $45.71 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $104.71
| Professional | | $41.69 | $51.29 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $81.28
| Professional | | $52.48 | $52.48 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $218.78
| Facility | | $53.70 | $64.57 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $70.79 / $181.97
| Professional | | $38.02 | $70.79 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $125.89
| Facility | | $30.20 | $43.65 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $100.00 / $131.83
| Professional | | $69.18 | $100.00 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $16.22
| Facility | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $125.89
| Professional | | $40.74 | $67.61 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50,118.72 / $75,857.76
| Facility | | $35.48 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $154.88
| Professional | | $66.07 | $77.62 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $91.20 / $123.03
| Facility | | $38.90 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $173.78
| Professional | | $34.67 | $72.44 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.50 / $41.69
| Facility | | $16.22 | $19.50 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $69.18 / $125.89
| Professional | | $40.74 | $69.18 | $125.89 |