- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $158.49
| Facility | | $43.65 | $53.70 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $67.61
| Professional | | $21.88 | $32.36 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $114.82
| Facility | | $56.23 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.90 / $61.66
| Professional | | $21.88 | $38.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $75.86 / $91.20
| Professional | | $38.02 | $75.86 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $75.86
| Facility | | $34.67 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $53.70
| Professional | | $34.67 | $43.65 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $70.79
| Facility | | $34.67 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $41.69
| Professional | | $34.67 | $34.67 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $102.33
| Facility | | $33.88 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $79.43
| Professional | | $32.36 | $45.71 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $104.71 / $144.54
| Facility | | $52.48 | $104.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $29.51 / $41.69
| Professional | | $26.92 | $29.51 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $56.23
| Facility | | $41.69 | $52.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $69.18
| Professional | | $20.89 | $26.30 | $69.18 |