- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $1,445.44
| Facility | | $38.90 | $52.48 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $41.69 / $41.69
| Professional | | $38.90 | $41.69 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $72.44 / $117.49
| Facility | | $39.81 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $66.07
| Professional | | $39.81 | $39.81 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $104.71
| Facility | | $44.67 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.92 / $39.81
| Professional | | $18.62 | $26.92 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $64.57
| Facility | | $26.30 | $50.12 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $43.65 / $60.26
| Facility | | $38.90 | $43.65 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $43.65 / $60.26
| Professional | | $38.90 | $43.65 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $42.66 / $91.20
| Facility | | $39.81 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $41.69 / $43.65
| Professional | | $39.81 | $41.69 | $43.65 |