- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $93.33 / $186.21
| Facility | | $50.12 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $251.19
| Professional | | $23.99 | $44.67 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $281.84
| Facility | | $83.18 | $112.20 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $61.66
| Professional | | $40.74 | $58.88 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $72.44 / $91.20
| Professional | | $43.65 | $72.44 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $72.44 / $151.36
| Facility | | $25.12 | $72.44 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $60.26
| Professional | | $16.98 | $22.39 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $77.62
| Professional | | $45.71 | $45.71 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $50.12
| Facility | | $15.85 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $22.39 / $41.69
| Professional | | $21.38 | $22.39 | $41.69 |