- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $47.86 / $186.21
| Facility | | $20.89 | $47.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $30.90
| Professional | | $14.13 | $19.05 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Professional | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $41.69
| Facility | | $21.88 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $20.89
| Professional | | $15.49 | $18.62 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $45.71 / $74.13
| Facility | | $21.88 | $45.71 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $22.39 / $32.36
| Professional | | $12.88 | $22.39 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $64.57
| Professional | | $16.22 | $32.36 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $42.66
| Facility | | $20.89 | $20.89 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $42.66
| Professional | | $20.89 | $20.89 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $57.54
| Facility | | $20.89 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $25.12
| Professional | | $18.62 | $18.62 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $54.95
| Facility | | $23.99 | $30.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $20.89
| Professional | | $15.49 | $18.62 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $25.12
| Facility | | $18.62 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.30 / $25.12
| Professional | | $8.71 | $12.30 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $10.72 / $37.15
| Professional | | $9.33 | $10.72 | $37.15 |