- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $128.82
| Facility | | $60.26 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $81.28
| Professional | | $67.61 | $67.61 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $77.62
| Facility | | $57.54 | $74.13 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $77.62
| Professional | | $72.44 | $74.13 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $190.55 / $229.09
| Facility | | $30.20 | $190.55 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $125.89
| Professional | | $69.18 | $87.10 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $138.04
| Facility | | $69.18 | $91.20 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $102.33
| Professional | | $69.18 | $69.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $81.28 / $102.33
| Professional | | $77.62 | $81.28 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $169.82 / $229.09
| Facility | | $0.83 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $169.82
| Professional | | $77.62 | $102.33 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $181.97
| Facility | | $69.18 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $125.89
| Professional | | $69.18 | $120.23 | $125.89 |