- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $109.65 / $144.54
| Facility | | $51.29 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $56.23
| Professional | | $51.29 | $51.29 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $87.10
| Professional | | $51.29 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $109.65
| Professional | | $64.57 | $72.44 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $128.82
| Facility | | $72.44 | $97.72 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $61.66
| Professional | | $43.65 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $6.17
| Professional | | $6.17 | $6.17 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $51.29 / $51.29
| Facility | | $7.59 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $75.86
| Facility | | $48.98 | $54.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $75.86
| Professional | | $48.98 | $54.95 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $91.20
| Facility | | $47.86 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $54.95
| Professional | | $42.66 | $51.29 | $54.95 |