- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $112.20 / $138.04
| Facility | | $43.65 | $112.20 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $117.49
| Professional | | $21.88 | $36.31 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $107.15 / $323.59
| Facility | | $42.66 | $107.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $134.90
| Professional | | $54.95 | $107.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | CO | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $213.80 / $275.42
| Facility | | $125.89 | $213.80 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $51.29 / $75.86
| Professional | | $40.74 | $51.29 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $199.53 / $213.80
| Facility | | $104.71 | $199.53 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $64.57
| Professional | | $40.74 | $40.74 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $89.13 / $144.54
| Facility | | $40.74 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $147.91
| Professional | | $37.15 | $56.23 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $51.29
| Facility | | $45.71 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $141.25
| Professional | | $33.11 | $50.12 | $141.25 |