- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $229.09
| Facility | | $64.57 | $79.43 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $93.33
| Professional | | $32.36 | $38.90 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $223.87
| Facility | | $83.18 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $169.82
| Professional | | $38.02 | $57.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $112.20 / $134.90
| Professional | | $56.23 | $112.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $51.29 / $75.86
| Facility | | $50.12 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $75.86
| Professional | | $38.90 | $51.29 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $104.71
| Facility | | $51.29 | $51.29 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $56.23
| Professional | | $51.29 | $51.29 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $151.36
| Facility | | $50.12 | $70.79 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $91.20
| Professional | | $51.29 | $67.61 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $204.17
| Facility | | $77.62 | $154.88 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $61.66
| Professional | | $39.81 | $43.65 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $83.18
| Facility | | $61.66 | $77.62 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $61.66
| Professional | | $21.38 | $21.38 | $61.66 |