- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $467.74
| Facility | | $79.43 | $117.49 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $125.89
| Professional | | $104.71 | $104.71 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $181.97
| Facility | | $83.18 | $120.23 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $79.43
| Professional | | $60.26 | $70.79 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $128.82
| Facility | | $72.44 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $114.82
| Professional | | $83.18 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $87.10
| Facility | | $79.43 | $79.43 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $208.93
| Facility | | $79.43 | $144.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $97.72
| Professional | | $72.44 | $72.44 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $208.93
| Facility | | $91.20 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $79.43
| Professional | | $60.26 | $70.79 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $95.50
| Facility | | $75.86 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $44.67 / $112.20
| Professional | | $43.65 | $44.67 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $144.54
| Professional | | $35.48 | $41.69 | $144.54 |