- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $95.50 / $363.08
| Facility | | $47.86 | $95.50 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $309.03
| Professional | | $33.88 | $47.86 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $102.33
| Facility | | $53.70 | $75.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $69.18
| Professional | | $43.65 | $51.29 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $109.65 / $165.96
| Facility | | $53.70 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $70.79
| Professional | | $29.51 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $147.91
| Facility | | $51.29 | $72.44 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $158.49
| Professional | | $51.29 | $75.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $102.33
| Facility | | $51.29 | $51.29 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $158.49
| Facility | | $51.29 | $89.13 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $61.66
| Professional | | $45.71 | $45.71 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $134.90
| Facility | | $58.88 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $69.18
| Professional | | $43.65 | $51.29 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $61.66
| Facility | | $51.29 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $61.66
| Professional | | $21.38 | $26.92 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $51.29 / $93.33
| Professional | | $22.91 | $51.29 | $93.33 |