- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $199.53
| Facility | | $64.57 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $109.65
| Professional | | $64.57 | $64.57 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $97.72 / $269.15
| Facility | | $57.54 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $60.26 / $95.50
| Professional | | $52.48 | $60.26 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $107.15
| Professional | | $79.43 | $79.43 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $173.78
| Facility | | $64.57 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $144.54
| Professional | | $52.48 | $52.48 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $134.90
| Facility | | $61.66 | $64.57 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $144.54
| Professional | | $64.57 | $64.57 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $104.71
| Professional | | $64.57 | $81.28 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $104.71
| Professional | | $50.12 | $64.57 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $134.90
| Facility | | $52.48 | $52.48 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $67.61 / $85.11
| Professional | | $63.10 | $67.61 | $85.11 |