- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $125.89 / $199.53
| Facility | | $42.66 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $83.18
| Professional | | $33.88 | $37.15 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $5,011.87
| Facility | | $245.47 | $323.59 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $45.71
| Professional | | $36.31 | $36.31 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $70.79 / $158.49
| Facility | | $33.11 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $58.88 / $114.82
| Professional | | $28.84 | $58.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $66.07
| Professional | | $21.88 | $26.92 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $79.43
| Professional | | $45.71 | $51.29 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $120.23 / $158.49
| Facility | | $37.15 | $120.23 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $57.54
| Professional | | $33.88 | $37.15 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $83.18
| Facility | | $45.71 | $64.57 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $83.18
| Professional | | $45.71 | $64.57 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $54.95
| Facility | | $26.92 | $45.71 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $79.43
| Professional | | $20.89 | $30.20 | $79.43 |