- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $91.20
| Facility | | $44.67 | $77.62 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $83.18
| Professional | | $30.90 | $39.81 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $162.18
| Facility | | $46.77 | $46.77 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $61.66 / $125.89
| Professional | | $21.38 | $61.66 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $69.18 / $120.23
| Facility | | $64.57 | $69.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $52.48
| Professional | | $32.36 | $46.77 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $1,047.13
| Facility | | $79.43 | $112.20 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $74.13
| Professional | | $21.38 | $37.15 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $223.87
| Facility | | $40.74 | $58.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $234.42
| Professional | | $19.50 | $31.62 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $46.77 / $56.23
| Facility | | $22.39 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $58.88
| Professional | | $19.50 | $28.18 | $58.88 |