- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $165.96 / $676.08
| Facility | | $46.77 | $165.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $331.13
| Professional | | $74.13 | $107.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $83.18 / $85.11
| Professional | | $81.28 | $83.18 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $162.18
| Facility | | $120.23 | $138.04 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $138.04 / $138.04
| Professional | | $10.96 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $562.34
| Facility | | $77.62 | $114.82 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $234.42
| Professional | | $64.57 | $104.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $117.49
| Professional | | $81.28 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $91.20 / $147.91
| Professional | | $81.28 | $91.20 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $123.03 / $138.04
| Facility | | $57.54 | $123.03 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $186.21
| Professional | | $47.86 | $57.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $138.04 / $138.04
| Professional | | $81.28 | $138.04 | $138.04 |