- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $52.48 / $141.25
| Facility | | $24.55 | $52.48 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $36.31
| Professional | | $18.20 | $22.91 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $48.98
| Facility | | $25.70 | $36.31 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $24.55
| Professional | | $18.20 | $21.88 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $54.95 / $79.43
| Facility | | $25.70 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $38.90
| Professional | | $15.14 | $25.70 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $64.57
| Professional | | $15.85 | $21.38 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $50.12
| Facility | | $24.55 | $24.55 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $42.66 / $74.13
| Facility | | $24.55 | $42.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $29.51
| Professional | | $21.88 | $21.88 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $64.57
| Facility | | $28.18 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $24.55
| Professional | | $18.20 | $21.88 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $29.51
| Facility | | $21.88 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.45 / $30.90
| Professional | | $10.23 | $14.45 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.59 / $43.65
| Professional | | $10.96 | $12.59 | $43.65 |