- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $151.36 / $245.47
| Facility | | $52.48 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $204.17
| Professional | | $40.74 | $46.77 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $5,011.87
| Facility | | $295.12 | $389.05 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $54.95
| Professional | | $43.65 | $43.65 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $85.11 / $190.55
| Facility | | $39.81 | $85.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $64.57 / $91.20
| Professional | | $25.12 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $56.23 / $81.28
| Professional | | $26.30 | $56.23 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $97.72
| Professional | | $56.23 | $63.10 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $147.91 / $190.55
| Facility | | $45.71 | $147.91 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $87.10
| Professional | | $40.74 | $46.77 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $77.62
| Facility | | $56.23 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $144.54
| Professional | | $56.23 | $77.62 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $67.61
| Facility | | $33.11 | $56.23 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $97.72
| Professional | | $25.12 | $36.31 | $97.72 |