- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $223.87 / $446.68
| Facility | | $89.13 | $223.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $295.12
| Professional | | $40.74 | $61.66 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $181.97 / $398.11
| Facility | | $36.31 | $181.97 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $120.23
| Professional | | $30.90 | $44.67 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $234.42 / $630.96
| Facility | | $75.86 | $234.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $144.54
| Professional | | $31.62 | $44.67 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $138.04 / $269.15
| Facility | | $50.12 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $52.48 / $141.25
| Professional | | $28.84 | $52.48 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $79.43 / $100.00
| Professional | | $38.02 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $181.97
| Professional | | $63.10 | $79.43 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $79.43
| Professional | | $38.90 | $38.90 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $199.53
| Facility | | $50.12 | $75.86 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $158.49
| Professional | | $28.84 | $47.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $131.83
| Professional | | $63.10 | $79.43 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $79.43
| Facility | | $29.51 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $147.91
| Professional | | $23.44 | $34.67 | $147.91 |