- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $181.97 / $295.12
| Facility | | $63.10 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $123.03
| Professional | | $48.98 | $54.95 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $5,011.87
| Facility | | $354.81 | $467.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $66.07
| Professional | | $52.48 | $52.48 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $102.33 / $229.09
| Facility | | $47.86 | $102.33 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $79.43 / $134.90
| Professional | | $33.11 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $97.72
| Professional | | $31.62 | $39.81 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $75.86 / $117.49
| Professional | | $67.61 | $75.86 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $177.83 / $229.09
| Facility | | $54.95 | $177.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $85.11
| Professional | | $48.98 | $54.95 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $93.33
| Facility | | $67.61 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $691.83
| Professional | | $67.61 | $93.33 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $81.28
| Facility | | $39.81 | $67.61 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $117.49
| Professional | | $28.18 | $43.65 | $117.49 |