- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $269.15 / $724.44
| Facility | | $66.07 | $269.15 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $199.53
| Professional | | $57.54 | $66.07 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $223.87
| Facility | | $134.90 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $199.53
| Professional | | $125.89 | $125.89 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $309.03 / $660.69
| Facility | | $104.71 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $257.04
| Professional | | $89.13 | $190.55 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $165.96
| Facility | | $66.07 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $251.19 / $316.23
| Professional | | $120.23 | $251.19 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $131.83 / $616.60
| Facility | | $66.07 | $131.83 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $147.91
| Professional | | $58.88 | $85.11 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $104.71
| Professional | | $54.95 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $263.03
| Professional | | $95.50 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $199.53 / $371.54
| Professional | | $134.90 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $269.15 / $616.60
| Facility | | $104.71 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $660.69
| Professional | | $89.13 | $165.96 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $134.90
| Facility | | $77.62 | $89.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $109.65
| Professional | | $51.29 | $66.07 | $109.65 |