- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $61.66 / $223.87
| Facility | | $30.90 | $61.66 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $41.69 / $199.53
| Professional | | $40.74 | $41.69 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $43.65 / $54.95
| Professional | | $19.95 | $43.65 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $83.18
| Facility | | $41.69 | $61.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $53.70
| Professional | | $35.48 | $41.69 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $85.11 / $107.15
| Facility | | $28.18 | $85.11 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $56.23
| Professional | | $21.88 | $43.65 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $186.21
| Facility | | $41.69 | $51.29 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $125.89
| Professional | | $41.69 | $56.23 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $75.86
| Professional | | $33.11 | $39.81 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $45.71
| Facility | | $41.69 | $41.69 | $45.71 |
- 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 / $72.44 / $128.82
| Facility | | $41.69 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $50.12
| Professional | | $37.15 | $37.15 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $61.66 / $95.50
| Facility | | $47.86 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $53.70
| Professional | | $35.48 | $41.69 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $50.12
| Facility | | $41.69 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $50.12
| Professional | | $26.30 | $29.51 | $50.12 |