- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $138.04 / $245.47
| Facility | | $77.62 | $138.04 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $151.36
| Professional | | $64.57 | $79.43 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $102.33 / $181.97
| Facility | | $89.13 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $50.12 / $123.03
| Professional | | $38.90 | $50.12 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $112.20
| Facility | | $63.10 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $131.83
| Professional | | $63.10 | $97.72 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $123.03 / $398.11
| Facility | | $66.07 | $123.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $147.91
| Professional | | $40.74 | $53.70 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $331.13
| Facility | | $63.10 | $63.10 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $51.29 / $89.13
| Professional | | $40.74 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $120.23
| Professional | | $74.13 | $89.13 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $199.53
| Professional | | $69.18 | $102.33 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $97.72 / $147.91
| Facility | | $44.67 | $97.72 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $112.20
| Professional | | $38.02 | $54.95 | $112.20 |