- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $83.18 / $190.55
| Facility | | $20.42 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $93.33
| Professional | | $23.99 | $32.36 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.38 / $45.71
| Professional | | $14.79 | $17.38 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $41.69
| Facility | | $30.90 | $35.48 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $35.48 / $42.66
| Professional | | $15.14 | $35.48 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $141.25
| Facility | | $28.84 | $42.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $75.86
| Professional | | $19.50 | $29.51 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $30.90
| Facility | | $21.38 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $35.48
| Professional | | $20.89 | $20.89 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $20.89 / $40.74
| Professional | | $4.68 | $20.89 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $31.62 / $43.65
| Facility | | $17.78 | $31.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $61.66
| Professional | | $14.13 | $20.42 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $33.11
| Professional | | $20.89 | $20.89 | $33.11 |