- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $33.88
| Facility | | $31.62 | $31.62 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $53.70
| Professional | | $11.48 | $11.48 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.72
| Professional | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $109.65
| Facility | | $43.65 | $54.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $74.13
| Professional | | $25.12 | $50.12 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $2.82 / $46.77
| Facility | | $1.15 | $2.82 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $22.91 / $48.98
| Professional | | $10.23 | $22.91 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $28.18 / $75.86
| Professional | | $13.18 | $28.18 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $72.44
| Facility | | $60.26 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $72.44
| Professional | | $60.26 | $72.44 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $48.98
| Facility | | $33.88 | $36.31 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $102.33
| Professional | | $36.31 | $70.79 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $54.95 / $109.65
| Facility | | $45.71 | $54.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $72.44
| Professional | | $25.12 | $31.62 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $14.13 / $35.48
| Facility | | $7.41 | $14.13 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $18.20 / $41.69
| Professional | | $8.51 | $18.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $25.12
| Professional | | $19.05 | $19.05 | $25.12 |