- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $223.87 / $645.65
| Facility | | $60.26 | $223.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $60.26 / $398.11
| Professional | | $47.86 | $60.26 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $128.82
| Facility | | $67.61 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $64.57
| Professional | | $47.86 | $57.54 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $141.25 / $229.09
| Facility | | $67.61 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $102.33
| Professional | | $39.81 | $67.61 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $67.61
| Professional | | $41.69 | $56.23 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $128.82
| Facility | | $64.57 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $74.13
| Professional | | $64.57 | $64.57 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $199.53
| Facility | | $64.57 | $112.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $79.43
| Professional | | $57.54 | $57.54 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $169.82
| Facility | | $74.13 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $64.57
| Professional | | $47.86 | $57.54 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $77.62
| Facility | | $57.54 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $89.13
| Professional | | $26.92 | $38.02 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $114.82
| Professional | | $28.84 | $33.11 | $114.82 |