- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $302.00
| Facility | | $75.86 | $109.65 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $81.28
| Professional | | $19.05 | $25.70 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $85.11
| Facility | | $52.48 | $52.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $48.98 / $58.88
| Professional | | $46.77 | $48.98 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $85.11
| Facility | | $63.10 | $63.10 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $120.23 / $257.04
| Facility | | $34.67 | $120.23 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $74.13 / $97.72
| Professional | | $25.70 | $74.13 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $64.57
| Facility | | $25.12 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $81.28
| Professional | | $46.77 | $64.57 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $51.29 / $229.09
| Facility | | $25.70 | $51.29 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $70.79
| Professional | | $22.39 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $58.88 / $70.79
| Professional | | $23.44 | $58.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Facility | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $102.33
| Professional | | $37.15 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $138.04
| Professional | | $52.48 | $77.62 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $104.71 / $275.42
| Facility | | $34.67 | $104.71 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $51.29 / $323.59
| Professional | | $25.70 | $51.29 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $52.48
| Facility | | $25.12 | $33.11 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $42.66
| Professional | | $19.05 | $25.70 | $42.66 |