- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $138.04
| Facility | | $38.90 | $47.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $47.86
| Professional | | $20.89 | $30.20 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $112.20
| Facility | | $50.12 | $81.28 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $58.88
| Professional | | $21.38 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $67.61 / $79.43
| Professional | | $63.10 | $67.61 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $47.86
| Facility | | $30.90 | $30.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $61.66
| Professional | | $30.90 | $41.69 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $61.66
| Facility | | $30.90 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $61.66
| Professional | | $28.18 | $30.90 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $93.33
| Facility | | $30.20 | $42.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $79.43
| Professional | | $30.90 | $37.15 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $93.33 / $128.82
| Facility | | $46.77 | $93.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $39.81
| Professional | | $23.44 | $31.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $37.15 / $50.12
| Facility | | $19.50 | $37.15 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $43.65
| Professional | | $12.88 | $17.78 | $43.65 |