- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $186.21
| Facility | | $43.65 | $66.07 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $69.18
| Professional | | $38.90 | $46.77 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $204.17 / $204.17
| Facility | | $147.91 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $46.77
| Professional | | $25.12 | $43.65 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $117.49 / $257.04
| Facility | | $38.02 | $117.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $81.28
| Professional | | $25.70 | $30.20 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $69.18
| Professional | | $46.77 | $46.77 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $40.74 / $93.33
| Facility | | $33.88 | $40.74 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $39.81
| Professional | | $36.31 | $36.31 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $56.23 / $97.72
| Facility | | $29.51 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $77.62
| Professional | | $28.18 | $33.88 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |