- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $114.82
| Facility | | $31.62 | $38.90 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $38.90
| Professional | | $16.98 | $23.99 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $85.11
| Facility | | $40.74 | $66.07 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.18 / $45.71
| Professional | | $16.22 | $28.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $54.95 / $64.57
| Professional | | $51.29 | $54.95 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $36.31
| Facility | | $25.12 | $25.12 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $47.86
| Professional | | $25.12 | $32.36 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $51.29
| Facility | | $25.12 | $25.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $35.48
| Professional | | $25.12 | $25.12 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $74.13
| Facility | | $22.91 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $30.20 / $79.43
| Professional | | $23.44 | $30.20 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $75.86 / $104.71
| Facility | | $38.02 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $30.20
| Professional | | $19.05 | $23.99 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $30.20 / $40.74
| Facility | | $14.79 | $30.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.49 / $33.11
| Professional | | $10.47 | $13.49 | $33.11 |