- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $87.10 / $151.36
| Facility | | $36.31 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $151.36
| Professional | | $28.18 | $33.88 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $39.81 / $69.18
| Facility | | $34.67 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $47.86
| Professional | | $18.62 | $23.44 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $46.77
| Facility | | $30.20 | $39.81 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $51.29
| Professional | | $24.55 | $38.02 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $48.98 / $154.88
| Facility | | $24.55 | $48.98 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $72.44
| Professional | | $19.05 | $24.55 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $48.98 / $141.25
| Facility | | $24.55 | $48.98 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $23.99 / $70.79
| Professional | | $2.09 | $23.99 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $46.77
| Professional | | $28.18 | $33.88 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $77.62
| Professional | | $26.30 | $39.81 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $38.02 / $56.23
| Facility | | $19.05 | $38.02 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $45.71
| Professional | | $15.85 | $22.39 | $45.71 |