- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $77.62 / $239.88
| Facility | | $31.62 | $77.62 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $50.12
| Professional | | $25.12 | $30.20 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $67.61
| Facility | | $35.48 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $33.88
| Professional | | $25.70 | $30.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $72.44 / $109.65
| Facility | | $35.48 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $53.70
| Professional | | $20.89 | $36.31 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $64.57
| Professional | | $21.88 | $30.20 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $67.61
| Facility | | $33.88 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $33.88
| Professional | | $30.90 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $104.71
| Facility | | $33.88 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $40.74
| Professional | | $30.90 | $30.90 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $89.13
| Facility | | $38.90 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $33.88
| Professional | | $25.70 | $30.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $40.74
| Facility | | $30.90 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $43.65
| Professional | | $14.13 | $19.95 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $17.38 / $61.66
| Professional | | $15.14 | $17.38 | $61.66 |