- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $79.43
| Facility | | $6.17 | $6.17 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.88 / $53.70
| Professional | | $32.36 | $33.88 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $117.49
| Facility | | $60.26 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $75.86 / $75.86
| Professional | | $66.07 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $69.18
| Facility | | $40.74 | $40.74 | $69.18 |
- 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
- $30.90 / $60.26 / $91.20
| Facility | | $30.90 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $64.57
| Professional | | $33.88 | $56.23 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $61.66
| Professional | | $30.20 | $30.20 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $77.62
| Facility | | $60.26 | $60.26 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $66.07
| Professional | | $44.67 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $72.44
| Professional | | $61.66 | $64.57 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $46.77
| Facility | | $32.36 | $40.74 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $38.90 / $52.48
| Professional | | $21.38 | $38.90 | $52.48 |