- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $109.65
| Facility | | $30.90 | $38.02 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $36.31
| Professional | | $15.85 | $22.91 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $87.10
| Facility | | $39.81 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $27.54 / $45.71
| Professional | | $16.60 | $27.54 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $53.70 / $63.10
| Professional | | $50.12 | $53.70 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $38.02
| Facility | | $24.55 | $24.55 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $43.65
| Professional | | $24.55 | $33.11 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $50.12
| Facility | | $24.55 | $24.55 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $31.62
| Professional | | $24.55 | $24.55 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $74.13
| Facility | | $23.99 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $79.43
| Professional | | $24.55 | $29.51 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $74.13 / $102.33
| Facility | | $37.15 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $30.90
| Professional | | $18.20 | $25.12 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $29.51 / $38.90
| Facility | | $15.49 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.13 / $33.88
| Professional | | $10.23 | $14.13 | $33.88 |