- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $158.49
| Facility | | $27.54 | $51.29 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $40.74
| Professional | | $15.85 | $25.12 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $54.95
| Facility | | $27.54 | $40.74 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $27.54
| Professional | | $20.42 | $24.55 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $60.26 / $70.79
| Facility | | $21.88 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $28.84 / $38.90
| Professional | | $12.02 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $23.99 / $64.57
| Professional | | $17.38 | $23.99 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $54.95
| Facility | | $27.54 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $54.95
| Professional | | $27.54 | $27.54 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $85.11
| Facility | | $27.54 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $33.11
| Professional | | $24.55 | $24.55 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $72.44
| Facility | | $30.90 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $27.54
| Professional | | $20.42 | $24.55 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $33.11
| Facility | | $24.55 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.48 / $27.54
| Professional | | $10.00 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.13 / $48.98
| Professional | | $12.30 | $14.13 | $48.98 |