- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $91.20 / $120.23
| Facility | | $42.66 | $91.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $45.71
| Professional | | $42.66 | $42.66 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $87.10 / $147.91
| Facility | | $43.65 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $74.13
| Professional | | $43.65 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $97.72
| Professional | | $56.23 | $64.57 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $109.65
| Facility | | $61.66 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $42.66 / $56.23
| Professional | | $37.15 | $42.66 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $69.18
| Facility | | $42.66 | $42.66 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $47.86 / $64.57
| Facility | | $41.69 | $47.86 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $47.86 / $64.57
| Professional | | $41.69 | $47.86 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $47.86 / $91.20
| Facility | | $42.66 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $53.70
| Professional | | $41.69 | $42.66 | $53.70 |