- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $218.78 / $467.74
| Facility | | $85.11 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $204.17
| Professional | | $63.10 | $75.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $52.48 / $72.44
| Professional | | $51.29 | $52.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $154.88
| Facility | | $77.62 | $89.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $114.82
| Professional | | $41.69 | $53.70 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $120.23
| Facility | | $67.61 | $97.72 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $114.82
| Professional | | $85.11 | $102.33 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $346.74
| Facility | | $91.20 | $112.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $169.82
| Professional | | $43.65 | $75.86 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $141.25 / $380.19
| Facility | | $54.95 | $141.25 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $75.86 / $169.82
| Professional | | $40.74 | $75.86 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $104.71
| Professional | | $64.57 | $75.86 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $190.55
| Professional | | $72.44 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $128.82
| Facility | | $75.86 | $85.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $120.23
| Professional | | $35.48 | $51.29 | $120.23 |