- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $128.82 / $309.03
| Facility | | $38.90 | $128.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $36.31 / $107.15
| Professional | | $29.51 | $36.31 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $83.18
| Professional | | $21.38 | $24.55 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $144.54
| Facility | | $87.10 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $30.90
| Professional | | $25.70 | $25.70 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $81.28 / $177.83
| Facility | | $26.92 | $81.28 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $57.54
| Professional | | $18.20 | $24.55 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $63.10 / $63.10
| Professional | | $58.88 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $66.07
| Facility | | $28.18 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $29.51 / $41.69
| Professional | | $27.54 | $29.51 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,238.72 / $3,630.78
| Facility | | $2,089.30 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $38.90 / $58.88
| Facility | | $17.78 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $23.99 / $47.86
| Professional | | $16.60 | $23.99 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |