- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $269.15
| Facility | | $75.86 | $93.33 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $56.23 / $91.20
| Professional | | $15.14 | $56.23 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $173.78
| Facility | | $97.72 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $66.07 / $107.15
| Professional | | $11.48 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $131.83 / $154.88
| Professional | | $123.03 | $131.83 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $60.26 / $75.86
| Facility | | $57.54 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $60.26 / $87.10
| Professional | | $22.91 | $60.26 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $120.23
| Facility | | $60.26 | $60.26 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $60.26 / $72.44
| Professional | | $25.70 | $60.26 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $83.18 / $173.78
| Facility | | $25.70 | $83.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $66.07 / $83.18
| Professional | | $22.91 | $66.07 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $177.83 / $234.42
| Facility | | $89.13 | $177.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $44.67 / $72.44
| Professional | | $16.98 | $44.67 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $72.44 / $95.50
| Facility | | $10.47 | $72.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $25.12 / $72.44
| Professional | | $9.55 | $25.12 | $72.44 |