- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $144.54 / $218.78
| Facility | | $46.77 | $144.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $173.78
| Professional | | $40.74 | $58.88 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $128.82 / $162.18
| Professional | | $43.65 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $89.13 / $128.82
| Professional | | $47.86 | $89.13 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $109.65 / $346.74
| Facility | | $46.77 | $109.65 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $83.18 / $354.81
| Professional | | $39.81 | $83.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $112.20 / $144.54
| Professional | | $58.88 | $112.20 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $128.82 / $144.54
| Professional | | $102.33 | $128.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $61.66 / $123.03
| Professional | | $56.23 | $61.66 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $245.47
| Facility | | $109.65 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $109.65
| Professional | | $38.90 | $60.26 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $117.49
| Professional | | $100.00 | $100.00 | $117.49 |