- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $69.18
| Professional | | $34.67 | $52.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $295.12
| Facility | | $190.55 | $263.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $5.13
| Professional | | $5.13 | $5.13 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $93.33
| Facility | | $87.10 | $87.10 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $61.66
| Facility | | $44.67 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $67.61
| Professional | | $38.02 | $38.02 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $416.87 / $416.87
| Facility | | $134.90 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $57.54 / $93.33
| Facility | | $25.12 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $79.43
| Professional | | $42.66 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $63.10 / $63.10
| Professional | | $6.31 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $57.54 / $93.33
| Facility | | $25.12 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $56.23
| Professional | | $38.02 | $38.02 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $26.92 / $50.12
| Facility | | $3.55 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $56.23
| Professional | | $30.20 | $41.69 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | | $69.18 | $69.18 | $69.18 |