- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $52.48 / $138.04
| Facility | | $43.65 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $52.48 / $97.72
| Professional | | $43.65 | $52.48 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $117.49
| Facility | | $112.20 | $112.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $123.03
| Professional | | $58.88 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $75.86
| Professional | | $66.07 | $66.07 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $66.07
| Facility | | $48.98 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $66.07
| Professional | | $48.98 | $48.98 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $154.88
| Professional | | $83.18 | $112.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $109.65
| Professional | | $56.23 | $72.44 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $72.44 / $128.82
| Facility | | $44.67 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $138.04
| Professional | | $41.69 | $60.26 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $323.59
| Facility | | $63.10 | $91.20 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $323.59
| Professional | | $63.10 | $91.20 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $134.90
| Facility | | $33.88 | $48.98 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $54.95 / $89.13
| Professional | | $50.12 | $54.95 | $89.13 |