- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $416.87 / $2,137.96
| Facility | | $54.95 | $416.87 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $199.53 / $478.63
| Professional | | $35.48 | $199.53 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $177.83 / $257.04
| Professional | | $34.67 | $177.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,258.93 / $1,995.26
| Facility | | $346.74 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $199.53 / $269.15
| Professional | | $45.71 | $199.53 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $204.17 / $371.54
| Professional | | $43.65 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $173.78 / $446.68
| Facility | | $38.90 | $173.78 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $218.78 / $416.87
| Professional | | $44.67 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,096.48 / $1,380.38
| Facility | | $199.53 | $1,096.48 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $173.78 / $416.87
| Professional | | $45.71 | $173.78 | $416.87 |