- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $104.71 / $407.38
| Facility | | $37.15 | $104.71 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $31.62 / $162.18
| Professional | | $19.05 | $31.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $72.44 / $95.50
| Facility | | $44.67 | $72.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $50.12
| Professional | | $18.20 | $30.20 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $60.26 / $69.18
| Professional | | $54.95 | $60.26 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $199.53
| Facility | | $26.92 | $26.92 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $42.66
| Professional | | $26.92 | $32.36 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $54.95
| Facility | | $26.92 | $26.92 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $30.20
| Professional | | $26.92 | $26.92 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $81.28
| Facility | | $26.30 | $38.02 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $79.43
| Professional | | $26.92 | $32.36 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $81.28 / $112.20
| Facility | | $40.74 | $81.28 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $33.88
| Professional | | $20.42 | $27.54 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $32.36 / $43.65
| Facility | | $12.59 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.18 / $32.36
| Professional | | $11.48 | $13.18 | $32.36 |