- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $288.40 / $489.78
| Facility | | $120.23 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $109.65
| Professional | | $57.54 | $74.13 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $48.98 / $173.78
| Facility | | $44.67 | $48.98 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $79.43 / $144.54
| Professional | | $41.69 | $79.43 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $537.03 / $1,174.90
| Facility | | $74.13 | $537.03 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $309.03
| Professional | | $114.82 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $7.41 / $302.00
| Facility | | $2.63 | $7.41 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $181.97
| Professional | | $38.90 | $60.26 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $309.03 / $630.96
| Professional | | $144.54 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Professional | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $60.26
| Professional | | $20.42 | $28.84 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $173.78
| Facility | | $58.88 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $58.88 / $181.97
| Professional | | $38.90 | $58.88 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $93.33
| Facility | | $58.88 | $72.44 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $131.83
| Professional | | $32.36 | $43.65 | $131.83 |