- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $316.23
| Facility | | $40.74 | $74.13 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $114.82
| Professional | | $28.18 | $39.81 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $151.36
| Facility | | $42.66 | $42.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $107.15
| Professional | | $21.38 | $41.69 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $91.20 / $104.71
| Facility | | $87.10 | $91.20 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $109.65
| Professional | | $30.20 | $42.66 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $239.88
| Facility | | $56.23 | $83.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $162.18
| Professional | | $20.89 | $37.15 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $380.19
| Facility | | $37.15 | $69.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $36.31 / $501.19
| Professional | | $17.78 | $36.31 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $52.48
| Facility | | $21.38 | $42.66 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $64.57
| Professional | | $17.78 | $25.70 | $64.57 |