- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $151.36 / $776.25
| Facility | | $36.31 | $151.36 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $323.59
| Professional | | $102.33 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $263.03
| Professional | | $114.82 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $107.15 / $151.36
| Professional | | $56.23 | $107.15 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $489.78 / $870.96
| Facility | | $275.42 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $331.13
| Professional | | $117.49 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $186.21 / $234.42
| Professional | | $154.88 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $281.84
| Facility | | $128.82 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $128.82 / $281.84
| Facility | | $43.65 | $128.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $147.91 / $354.81
| Professional | | $48.98 | $147.91 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $177.83 / $263.03
| Facility | | $48.98 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $331.13
| Professional | | $109.65 | $181.97 | $331.13 |