- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $56.23 / $165.96
| Facility | | $45.71 | $56.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $56.23
| Professional | | $19.05 | $33.88 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $107.15
| Facility | | $58.88 | $95.50 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $40.74 / $66.07
| Professional | | $18.20 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $81.28 / $93.33
| Professional | | $74.13 | $81.28 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $50.12
| Facility | | $36.31 | $36.31 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $52.48
| Professional | | $24.55 | $36.31 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $74.13
| Facility | | $36.31 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $43.65
| Professional | | $36.31 | $36.31 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $107.15
| Facility | | $35.48 | $51.29 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $79.43
| Professional | | $24.55 | $39.81 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $144.54
| Facility | | $54.95 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $43.65
| Professional | | $18.62 | $27.54 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $43.65 / $58.88
| Facility | | $17.38 | $43.65 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.49 / $43.65
| Professional | | $15.14 | $15.49 | $43.65 |