- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $102.33
| Facility | | $28.84 | $35.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $20.89 / $35.48
| Professional | | $12.02 | $20.89 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $60.26 / $66.07
| Facility | | $37.15 | $60.26 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $25.70 / $40.74
| Professional | | $11.75 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $50.12 / $58.88
| Professional | | $46.77 | $50.12 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $32.36
| Facility | | $22.91 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $34.67
| Professional | | $22.91 | $26.30 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $45.71
| Facility | | $22.91 | $22.91 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $43.65
| Professional | | $22.91 | $22.91 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $31.62 / $66.07
| Facility | | $16.98 | $31.62 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $79.43
| Professional | | $20.89 | $25.12 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $69.18 / $95.50
| Facility | | $34.67 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $20.89 / $27.54
| Professional | | $17.38 | $20.89 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $27.54 / $37.15
| Facility | | $10.72 | $27.54 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.77 / $27.54
| Professional | | $9.55 | $9.77 | $27.54 |