- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $67.61 / $371.54
| Facility | | $35.48 | $67.61 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $123.03
| Professional | | $25.70 | $45.71 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $2,137.96
| Facility | | $758.58 | $1,071.52 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $100.00
| Professional | | $27.54 | $51.29 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $125.89
| Professional | | $25.12 | $50.12 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $162.18
| Facility | | $40.74 | $67.61 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $128.82
| Professional | | $40.74 | $66.07 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $102.33
| Facility | | $61.66 | $97.72 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $67.61
| Facility | | $51.29 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $51.29 / $114.82
| Professional | | $26.92 | $51.29 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $2,137.96
| Facility | | $724.44 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $95.50
| Professional | | $27.54 | $51.29 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,513.56 / $2,754.23
| Facility | | $1,148.15 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $97.72
| Professional | | $27.54 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $109.65
| Professional | | $58.88 | $70.79 | $109.65 |