- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $56.23 / $165.96
| Facility | | $29.51 | $56.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $87.10
| Professional | | $30.90 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $60.26
| Professional | | $33.88 | $51.29 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $5,011.87
| Facility | | $29.51 | $34.67 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $114.82 / $123.03
| Facility | | $33.11 | $114.82 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $57.54 / $57.54
| Professional | | $50.12 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $60.26 / $151.36
| Facility | | $25.12 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $87.10
| Facility | | $33.11 | $61.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $54.95
| Professional | | $33.11 | $33.11 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $37.15
| Facility | | $30.20 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $37.15
| Professional | | $30.20 | $34.67 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $32.36
| Facility | | $30.90 | $30.90 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $36.31 / $44.67
| Professional | | $29.51 | $36.31 | $44.67 |