- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $295.12
| Facility | | $83.18 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $123.03
| Professional | | $44.67 | $52.48 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $131.83
| Professional | | $48.98 | $57.54 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $257.04 / $524.81
| Facility | | $107.15 | $257.04 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $134.90
| Professional | | $67.61 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $147.91
| Professional | | $50.12 | $81.28 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $120.23
| Facility | | $42.66 | $70.79 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $114.82
| Professional | | $42.66 | $64.57 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $32.36 / $38.02
| Professional | | $30.90 | $32.36 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $97.72
| Facility | | $61.66 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $131.83
| Professional | | $66.07 | $87.10 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $524.81
| Facility | | $194.98 | $269.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $93.33 / $125.89
| Professional | | $66.07 | $93.33 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $354.81 / $645.65
| Facility | | $269.15 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $138.04
| Professional | | $54.95 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $109.65
| Professional | | $52.48 | $57.54 | $109.65 |