- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $138.04
| Facility | | $33.11 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $54.95
| Professional | | $30.90 | $34.67 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $144.54
| Facility | | $93.33 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $42.66 / $63.10
| Professional | | $31.62 | $42.66 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $91.20 / $190.55
| Facility | | $34.67 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $72.44
| Professional | | $19.50 | $30.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $102.33
| Facility | | $33.88 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $43.65
| Professional | | $41.69 | $41.69 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $72.44
| Facility | | $35.48 | $54.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $58.88
| Professional | | $17.38 | $25.12 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $263.03
| Facility | | $199.53 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $363.08 / $363.08
| Professional | | $316.23 | $363.08 | $363.08 |