- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $114.82 / $354.81
| Facility | | $58.88 | $114.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $63.10
| Professional | | $57.54 | $57.54 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $72.44
| Professional | | $57.54 | $57.54 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $186.21
| Facility | | $69.18 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $64.57 / $107.15
| Professional | | $57.54 | $64.57 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $57.54 / $70.79
| Facility | | $30.20 | $57.54 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $102.33 / $114.82
| Professional | | $3.24 | $102.33 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $53.70 / $70.79
| Facility | | $30.20 | $53.70 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $309.03
| Professional | | $53.70 | $53.70 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $64.57 / $85.11
| Professional | | $57.54 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $53.70
| Facility | | $51.29 | $51.29 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $89.13
| Professional | | $40.74 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $173.78
| Professional | | $57.54 | $91.20 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $223.87
| Facility | | $57.54 | $85.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $309.03
| Professional | | $57.54 | $93.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $95.50
| Professional | | $37.15 | $58.88 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $117.49
| Facility | | $50.12 | $50.12 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $57.54 / $63.10
| Professional | | $50.12 | $57.54 | $63.10 |