- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $134.90
| Facility | | $32.36 | $41.69 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $53.70
| Professional | | $26.92 | $32.36 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $128.82
| Facility | | $91.20 | $112.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $52.48
| Professional | | $28.18 | $37.15 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $89.13 / $186.21
| Facility | | $30.90 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $22.91 / $58.88
| Professional | | $17.38 | $22.91 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $75.86
| Facility | | $32.36 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $42.66
| Professional | | $40.74 | $40.74 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $45.71 / $47.86
| Facility | | $22.91 | $45.71 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $25.12 / $69.18
| Professional | | $22.39 | $25.12 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $398.11
| Professional | | $302.00 | $398.11 | $398.11 |