- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $186.21 / $562.34
| Facility | | $58.88 | $186.21 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $229.09
| Professional | | $48.98 | $75.86 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $181.97 / $478.63
| Facility | | $85.11 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $245.47
| Professional | | $57.54 | $102.33 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $257.04
| Facility | | $158.49 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $114.82 / $186.21
| Facility | | $46.77 | $114.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $97.72 / $218.78
| Professional | | $35.48 | $97.72 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $69.18 / $131.83
| Facility | | $31.62 | $69.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $123.03
| Professional | | $35.48 | $63.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $199.53
| Professional | | $77.62 | $95.50 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $199.53 / $302.00
| Facility | | $138.04 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $181.97 / $478.63
| Facility | | $85.11 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $245.47
| Professional | | $57.54 | $102.33 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $61.66 / $398.11
| Facility | | $57.54 | $61.66 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $75.86
| Facility | | $53.70 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $97.72 / $213.80
| Professional | | $36.31 | $97.72 | $213.80 |