- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $478.63
| Facility | | $107.15 | $154.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $181.97
| Professional | | $81.28 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $158.49 / $223.87
| Professional | | $154.88 | $158.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $218.78 / $436.52
| Facility | | $204.17 | $218.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $269.15
| Professional | | $95.50 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $316.23
| Facility | | $199.53 | $245.47 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $457.09
| Professional | | $213.80 | $275.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $141.25
| Facility | | $125.89 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $125.89
| Professional | | $93.33 | $93.33 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $125.89
| Facility | | $107.15 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $138.04
| Professional | | $93.33 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $158.49
| Professional | | $77.62 | $109.65 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $416.87
| Professional | | $194.98 | $229.09 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $165.96 / $245.47
| Facility | | $70.79 | $165.96 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $151.36
| Professional | | $67.61 | $97.72 | $151.36 |