- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $162.18 / $162.18
| Facility | | $33.88 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $36.31
| Professional | | $18.20 | $25.12 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.45 / $60.26
| Facility | | $1.51 | $2.45 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $46.77
| Professional | | $17.38 | $34.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $66.07
| Professional | | $42.66 | $50.12 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $54.95
| Facility | | $18.62 | $30.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $42.66
| Professional | | $19.05 | $26.30 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $46.77
| Facility | | $38.90 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $63.10
| Professional | | $38.90 | $46.77 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $54.95
| Facility | | $18.20 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $79.43
| Professional | | $21.88 | $40.74 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $676.08
| Facility | | $407.38 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $87.10
| Professional | | $47.86 | $67.61 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $831.76
| Facility | | $512.86 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.13 / $33.88
| Professional | | $9.55 | $14.13 | $33.88 |