- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $190.55
| Facility | | $52.48 | $64.57 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $74.13
| Professional | | $26.92 | $38.90 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $125.89
| Facility | | $69.18 | $112.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $46.77 / $75.86
| Professional | | $23.99 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $112.20
| Professional | | $46.77 | $91.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $42.66 / $93.33
| Facility | | $40.74 | $42.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $63.10
| Professional | | $42.66 | $50.12 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $85.11
| Facility | | $42.66 | $42.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $51.29
| Professional | | $42.66 | $42.66 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $125.89
| Facility | | $40.74 | $61.66 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $79.43
| Professional | | $38.02 | $52.48 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $125.89 / $173.78
| Facility | | $63.10 | $125.89 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $36.31 / $51.29
| Professional | | $33.11 | $36.31 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $67.61
| Facility | | $51.29 | $63.10 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.18 / $85.11
| Professional | | $25.70 | $28.18 | $85.11 |