- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $173.78
| Facility | | $47.86 | $58.88 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $36.31 / $58.88
| Professional | | $12.88 | $36.31 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $112.20
| Facility | | $63.10 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $42.66 / $69.18
| Professional | | $8.91 | $42.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $97.72
| Professional | | $79.43 | $85.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $47.86
| Facility | | $38.90 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $38.90 / $54.95
| Professional | | $19.05 | $38.90 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $77.62
| Facility | | $38.90 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $72.44
| Professional | | $38.90 | $38.90 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $114.82
| Facility | | $37.15 | $53.70 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $42.66 / $75.86
| Professional | | $18.20 | $42.66 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $112.20 / $151.36
| Facility | | $57.54 | $112.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $28.84 / $46.77
| Professional | | $14.45 | $28.84 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $46.77 / $61.66
| Facility | | $8.71 | $46.77 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $16.22 / $46.77
| Professional | | $8.13 | $16.22 | $46.77 |