- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $104.71 / $338.84
| Facility | | $46.77 | $104.71 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $95.50
| Professional | | $32.36 | $38.90 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $95.50
| Facility | | $46.77 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $63.10
| Professional | | $39.81 | $46.77 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $162.18
| Facility | | $48.98 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $50.12 / $66.07
| Professional | | $23.99 | $50.12 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $147.91
| Facility | | $46.77 | $58.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $134.90
| Professional | | $46.77 | $58.88 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $75.86
| Professional | | $38.02 | $45.71 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $95.50
| Facility | | $46.77 | $46.77 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $95.50
| Professional | | $46.77 | $46.77 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $158.49
| Facility | | $46.77 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $56.23
| Professional | | $42.66 | $42.66 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $125.89
| Facility | | $54.95 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $63.10
| Professional | | $39.81 | $46.77 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $56.23
| Facility | | $46.77 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $52.48
| Professional | | $19.95 | $19.95 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $46.77 / $85.11
| Professional | | $21.38 | $46.77 | $85.11 |