- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $138.04 / $371.54
| Facility | | $33.88 | $138.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $75.86 / $173.78
| Professional | | $28.18 | $75.86 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $295.12
| Facility | | $67.61 | $107.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $616.60
| Professional | | $30.90 | $85.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $89.13 / $131.83
| Facility | | $33.11 | $89.13 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $102.33 / $229.09
| Professional | | $54.95 | $102.33 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $134.90 / $223.87
| Facility | | $67.61 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $199.53
| Professional | | $33.11 | $87.10 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $54.95
| Facility | | $12.59 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $81.28 / $151.36
| Professional | | $43.65 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $87.10 / $204.17
| Professional | | $28.84 | $87.10 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $295.12
| Facility | | $67.61 | $107.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $616.60
| Professional | | $30.90 | $85.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $281.84
| Facility | | $100.00 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $81.28 / $213.80
| Professional | | $30.90 | $81.28 | $213.80 |