- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $398.11
| Facility | | $64.57 | $128.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $131.83
| Professional | | $38.02 | $64.57 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $138.04
| Facility | | $69.18 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $69.18 / $89.13
| Professional | | $58.88 | $69.18 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $144.54 / $218.78
| Facility | | $70.79 | $144.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $72.44 / $100.00
| Professional | | $42.66 | $72.44 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $117.49 / $213.80
| Facility | | $69.18 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $134.90 / $213.80
| Professional | | $69.18 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $75.86
| Professional | | $60.26 | $66.07 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $138.04
| Facility | | $69.18 | $69.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $75.86
| Professional | | $69.18 | $69.18 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $213.80
| Facility | | $69.18 | $109.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $83.18
| Professional | | $61.66 | $61.66 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $181.97
| Facility | | $69.18 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $69.18 / $89.13
| Professional | | $58.88 | $69.18 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $83.18
| Facility | | $69.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $141.25
| Professional | | $40.74 | $58.88 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $69.18 / $123.03
| Professional | | $30.90 | $69.18 | $123.03 |