- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $154.88 / $389.05
| Facility | | $53.70 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $63.10 / $128.82
| Professional | | $26.92 | $63.10 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $371.54
| Facility | | $57.54 | $89.13 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $69.18 / $190.55
| Professional | | $23.99 | $69.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $223.87
| Facility | | $125.89 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $74.13 / $74.13
| Professional | | $36.31 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $60.26 / $125.89
| Facility | | $31.62 | $60.26 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $77.62 / $138.04
| Professional | | $21.88 | $77.62 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $223.87 / $7,079.46
| Facility | | $32.36 | $223.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $134.90
| Professional | | $114.82 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $165.96
| Professional | | $79.43 | $79.43 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $281.84 / $302.00
| Facility | | $70.79 | $281.84 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $371.54
| Facility | | $57.54 | $89.13 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $69.18 / $190.55
| Professional | | $23.99 | $69.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $112.20
| Facility | | $28.84 | $28.84 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $46.77 / $79.43
| Facility | | $23.44 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $46.77 / $151.36
| Professional | | $14.13 | $46.77 | $151.36 |