- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $125.89 / $22,387.21
| Facility | | $54.95 | $125.89 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $8,912.51
| Professional | | $54.95 | $54.95 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $186.21
| Facility | | $54.95 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $97.72
| Professional | | $54.95 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $74.13
| Professional | | $54.95 | $54.95 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $138.04
| Facility | | $57.54 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $66.07
| Professional | | $46.77 | $54.95 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $58.88 / $91.20
| Facility | | $54.95 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $57.54
| Professional | | $54.95 | $54.95 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $66.07 / $81.28
| Facility | | $52.48 | $66.07 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $66.07 / $81.28
| Professional | | $52.48 | $66.07 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $54.95 / $114.82
| Facility | | $52.48 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $58.88 / $61.66
| Professional | | $54.95 | $58.88 | $61.66 |