- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.75
| Professional | | $1.00 | $1.00 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $0.98 / $1.12
| Facility | | $0.87 | $0.98 | $1.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $1.02 / $1.66
| Professional | | $0.85 | $1.02 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $263.03
| Facility | | $91.20 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $87.10
| Professional | | $39.81 | $39.81 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $5.37 / $6.31
| Professional | | $5.37 | $5.37 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $281.84 / $831.76
| Professional | | $5.89 | $281.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $141.25
| Professional | | $60.26 | $60.26 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.87 / $1.48
| Facility | | $0.81 | $0.87 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $89.13
| Professional | | $60.26 | $79.43 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $1.02 / $1.45
| Professional | | $0.85 | $1.02 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $104.71 / $138.04
| Facility | | $87.10 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $134.90 / $134.90
| Professional | | $44.67 | $134.90 | $134.90 |