- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $77.62 / $7,413.10
| Facility | | $26.92 | $77.62 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $28.18 / $36.31
| Professional | | $26.92 | $28.18 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $53.70 / $91.20
| Facility | | $26.92 | $53.70 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $44.67
| Professional | | $26.92 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $58.88
| Professional | | $33.88 | $38.90 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $67.61
| Facility | | $36.31 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Professional | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $91.20
| Professional | | $22.91 | $27.54 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $95.50
| Facility | | $27.54 | $27.54 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $75.86
| Facility | | $25.70 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $75.86
| Professional | | $25.70 | $39.81 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $74.13
| Facility | | $26.92 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $34.67
| Professional | | $26.92 | $27.54 | $34.67 |