- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $407.38
| Professional | | $39.81 | $61.66 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.13
| Facility | | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $91.20 / $263.03
| Professional | | $48.98 | $91.20 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $199.53 / $302.00
| Facility | | $154.88 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $398.11
| Professional | | $60.26 | $104.71 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $97.72
| Facility | | $74.13 | $74.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $131.83
| Professional | | $63.10 | $74.13 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $112.20
| Professional | | $93.33 | $93.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $154.88
| Professional | | $77.62 | $91.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $549.54 / $549.54
| Facility | | $177.83 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $74.13 / $131.83
| Facility | | $36.31 | $74.13 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $81.28
| Professional | | $63.10 | $74.13 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Professional | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $93.33 / $95.50
| Professional | | $87.10 | $93.33 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $36.31 / $67.61
| Facility | | $3.89 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $128.82
| Professional | | $40.74 | $58.88 | $128.82 |