- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $134.90
| Facility | | $42.66 | $51.29 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $102.33
| Professional | | $42.66 | $52.48 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $114.82
| Facility | | $107.15 | $107.15 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $125.89
| Professional | | $60.26 | $60.26 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $74.13
| Professional | | $56.23 | $56.23 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $61.66
| Facility | | $43.65 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $61.66
| Professional | | $44.67 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $151.36
| Professional | | $81.28 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $104.71
| Professional | | $56.23 | $70.79 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $125.89
| Facility | | $42.66 | $69.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $63.10 / $134.90
| Professional | | $57.54 | $63.10 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $309.03
| Facility | | $60.26 | $87.10 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $309.03
| Professional | | $60.26 | $87.10 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $107.15
| Facility | | $30.90 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $52.48 / $85.11
| Professional | | $48.98 | $52.48 | $85.11 |