- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $75.86 / $190.55
| Facility | | $41.69 | $75.86 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $85.11
| Professional | | $41.69 | $41.69 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $123.03
| Facility | | $69.18 | $69.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $47.86 / $77.62
| Professional | | $21.38 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $93.33 / $107.15
| Professional | | $87.10 | $93.33 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $87.10
| Facility | | $41.69 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $61.66
| Professional | | $41.69 | $48.98 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $46.77
| Facility | | $41.69 | $41.69 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $123.03
| Facility | | $41.69 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $58.88
| Professional | | $38.02 | $46.77 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $154.88
| Facility | | $63.10 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $50.12
| Professional | | $31.62 | $41.69 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $50.12 / $67.61
| Facility | | $19.05 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $41.69
| Professional | | $17.78 | $17.78 | $41.69 |