- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $162.18
| Facility | | $26.30 | $39.81 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $32.36
| Professional | | $14.13 | $19.95 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $75.86
| Facility | | $33.88 | $54.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $23.44 / $39.81
| Professional | | $14.45 | $23.44 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $46.77 / $53.70
| Professional | | $42.66 | $46.77 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $32.36
| Facility | | $20.89 | $20.89 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $42.66
| Professional | | $20.89 | $28.18 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $42.66
| Facility | | $20.89 | $20.89 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $20.89 / $42.66
| Professional | | $19.05 | $20.89 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $63.10
| Facility | | $20.42 | $29.51 | $63.10 |
- 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
- $31.62 / $63.10 / $87.10
| Facility | | $31.62 | $63.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $26.92
| Professional | | $15.85 | $21.38 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $25.12 / $33.88
| Facility | | $13.18 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $29.51
| Professional | | $8.91 | $12.02 | $29.51 |