- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $141.25 / $229.09
| Facility | | $57.54 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $70.79
| Professional | | $34.67 | $45.71 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $181.97
| Facility | | $83.18 | $134.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $95.50
| Professional | | $34.67 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $112.20 / $128.82
| Professional | | $104.71 | $112.20 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $162.18
| Facility | | $51.29 | $51.29 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $93.33
| Professional | | $51.29 | $64.57 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $102.33
| Facility | | $51.29 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $95.50
| Professional | | $51.29 | $51.29 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $154.88
| Facility | | $48.98 | $70.79 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $91.20
| Professional | | $51.29 | $61.66 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $151.36 / $208.93
| Facility | | $75.86 | $151.36 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $64.57
| Professional | | $38.02 | $52.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $61.66 / $81.28
| Facility | | $31.62 | $61.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $70.79
| Professional | | $21.38 | $28.84 | $70.79 |