- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $83.18 / $154.88
| Facility | | $37.15 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $37.15
| Professional | | $16.60 | $23.44 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $93.33
| Facility | | $41.69 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $48.98
| Professional | | $17.78 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $66.07
| Professional | | $52.48 | $57.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $128.82
| Facility | | $25.70 | $25.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $52.48
| Professional | | $25.70 | $34.67 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $52.48
| Facility | | $25.70 | $25.70 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $48.98
| Professional | | $25.70 | $25.70 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $77.62
| Facility | | $25.12 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $79.43
| Professional | | $25.70 | $30.90 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $77.62 / $107.15
| Facility | | $38.90 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $33.11
| Professional | | $19.50 | $26.30 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $41.69
| Facility | | $16.22 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $36.31
| Professional | | $10.96 | $14.79 | $36.31 |