- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $181.97 / $389.05
| Facility | | $75.86 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $186.21
| Professional | | $36.31 | $48.98 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $144.54 / $309.03
| Facility | | $28.84 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $97.72
| Professional | | $24.55 | $37.15 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $204.17 / $549.54
| Facility | | $66.07 | $204.17 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $123.03
| Professional | | $27.54 | $38.90 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $107.15 / $208.93
| Facility | | $40.74 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $112.20
| Professional | | $25.12 | $44.67 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $61.66 / $97.72
| Professional | | $23.99 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $138.04
| Professional | | $48.98 | $61.66 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $74.13
| Professional | | $37.15 | $37.15 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $154.88
| Facility | | $39.81 | $58.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $123.03
| Professional | | $25.12 | $40.74 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Professional | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $61.66
| Professional | | $34.67 | $47.86 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $61.66
| Facility | | $25.12 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $117.49
| Professional | | $19.95 | $28.18 | $117.49 |