- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $40.74
| Facility | | $25.12 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $48.98
| Professional | | $21.88 | $30.90 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $54.95
| Facility | | $34.67 | $34.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $29.51
| Professional | | $21.88 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $100.00
| Professional | | $48.98 | $69.18 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Facility | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $53.70
| Professional | | $31.62 | $37.15 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $44.67
| Professional | | $21.88 | $30.90 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $74.13 / $102.33
| Professional | | $0.60 | $74.13 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $50.12
| Facility | | $37.15 | $37.15 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $50.12
| Professional | | $37.15 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $21.88 / $33.11
| Facility | | $17.38 | $21.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $53.70
| Professional | | $18.20 | $26.30 | $53.70 |