- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $53.70 / $53.70
| Facility | | $52.48 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $75.86
| Professional | | $41.69 | $53.70 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $109.65
| Facility | | $102.33 | $102.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $120.23
| Professional | | $57.54 | $57.54 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $70.79
| Professional | | $53.70 | $53.70 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $60.26 / $60.26
| Facility | | $47.86 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $60.26
| Professional | | $43.65 | $43.65 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $144.54
| Professional | | $77.62 | $102.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $102.33
| Professional | | $47.86 | $67.61 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $131.83
| Facility | | $41.69 | $72.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $67.61
| Professional | | $54.95 | $57.54 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $302.00
| Facility | | $58.88 | $85.11 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $302.00
| Professional | | $58.88 | $85.11 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $102.33
| Facility | | $37.15 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $50.12 / $79.43
| Professional | | $46.77 | $50.12 | $79.43 |