- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $75.86 / $281.84
| Facility | | $66.07 | $75.86 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $97.72
| Professional | | $54.95 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $229.09
| Professional | | $63.10 | $93.33 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $371.54
| Facility | | $190.55 | $251.19 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $144.54 / $263.03
| Professional | | $53.70 | $144.54 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $100.00
| Facility | | $60.26 | $72.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $190.55
| Professional | | $87.10 | $125.89 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $107.15
| Facility | | $60.26 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $446.68
| Professional | | $58.88 | $109.65 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $190.55
| Professional | | $56.23 | $77.62 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $204.17
| Professional | | $83.18 | $120.23 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $389.05
| Facility | | $154.88 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $85.11 / $446.68
| Professional | | $50.12 | $85.11 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $85.11
| Professional | | $75.86 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $257.04
| Professional | | $72.44 | $128.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $63.10
| Facility | | $56.23 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $295.12
| Professional | | $61.66 | $91.20 | $295.12 |