- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $177.83
| Facility | | $48.98 | $60.26 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $83.18
| Professional | | $28.84 | $36.31 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $125.89
| Facility | | $64.57 | $102.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $70.79
| Professional | | $29.51 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $85.11 / $104.71
| Professional | | $43.65 | $85.11 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.90 / $58.88
| Facility | | $38.02 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $57.54
| Professional | | $35.48 | $38.90 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $79.43
| Facility | | $38.90 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $79.43
| Professional | | $38.90 | $38.90 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $114.82
| Facility | | $38.02 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $79.43
| Professional | | $38.90 | $51.29 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $117.49 / $154.88
| Facility | | $58.88 | $117.49 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.11 / $46.77
| Professional | | $30.90 | $33.11 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $63.10
| Facility | | $46.77 | $58.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $46.77
| Professional | | $16.60 | $16.60 | $46.77 |