- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $74.13 / $199.53
| Facility | | $30.90 | $74.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $50.12
| Professional | | $21.88 | $30.90 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $67.61
| Facility | | $33.88 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $33.88
| Professional | | $25.12 | $30.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $75.86 / $89.13
| Facility | | $31.62 | $75.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $35.48 / $48.98
| Professional | | $16.98 | $35.48 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $64.57
| Professional | | $21.88 | $29.51 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $67.61
| Facility | | $33.88 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $38.90
| Professional | | $33.88 | $33.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $104.71
| Facility | | $33.88 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $40.74
| Professional | | $30.20 | $30.20 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $89.13
| Facility | | $33.88 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $33.88
| Professional | | $25.12 | $30.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $40.74
| Facility | | $30.20 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.45 / $34.67
| Professional | | $14.13 | $14.45 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $17.38 / $60.26
| Professional | | $15.14 | $17.38 | $60.26 |