- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $263.03 / $616.60
| Facility | | $34.67 | $263.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $79.43
| Professional | | $26.92 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $81.28
| Professional | | $36.31 | $43.65 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $87.10 / $194.98
| Facility | | $43.65 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $58.88
| Professional | | $26.30 | $39.81 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $74.13
| Professional | | $35.48 | $53.70 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $114.82 / $114.82
| Facility | | $25.12 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $81.28
| Professional | | $30.90 | $46.77 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $1,288.25
| Facility | | $54.95 | $56.23 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $363.08 / $363.08
| Professional | | $309.03 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $46.77 / $93.33
| Facility | | $28.84 | $46.77 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $83.18
| Professional | | $28.18 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $36.31
| Professional | | $23.44 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $100.00 / $173.78
| Professional | | $91.20 | $100.00 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $77.62
| Facility | | $28.84 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $79.43
| Professional | | $30.90 | $47.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $851.14 / $2,290.87
| Facility | | $114.82 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $60.26
| Professional | | $25.12 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $45.71 / $46.77
| Professional | | $44.67 | $45.71 | $46.77 |