- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $186.21 / $457.09
| Facility | | $38.02 | $186.21 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $22.91 / $38.90
| Professional | | $16.60 | $22.91 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $75.86
| Facility | | $42.66 | $69.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $28.84 / $46.77
| Professional | | $13.18 | $28.84 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $57.54 / $66.07
| Professional | | $53.70 | $57.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $389.05
| Facility | | $26.30 | $38.02 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $40.74
| Professional | | $26.30 | $30.20 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $52.48
| Facility | | $26.30 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $30.20
| Professional | | $26.30 | $26.30 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $77.62
| Facility | | $23.44 | $36.31 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $79.43
| Professional | | $23.44 | $28.84 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $77.62 / $107.15
| Facility | | $38.90 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $31.62
| Professional | | $19.50 | $23.99 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $31.62 / $41.69
| Facility | | $12.30 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $31.62
| Professional | | $10.96 | $10.96 | $31.62 |