- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $204.17
| Facility | | $30.90 | $50.12 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $60.26
| Professional | | $18.20 | $28.84 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $63.10
| Facility | | $30.90 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $40.74
| Professional | | $26.30 | $30.90 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $69.18 / $81.28
| Facility | | $25.70 | $69.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $29.51 / $42.66
| Professional | | $13.80 | $29.51 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.02 / $83.18
| Facility | | $28.18 | $38.02 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $83.18
| Professional | | $28.18 | $39.81 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $75.86
| Professional | | $27.54 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $63.10
| Facility | | $30.90 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $34.67
| Professional | | $30.90 | $30.90 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $97.72
| Facility | | $30.90 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $37.15
| Professional | | $28.18 | $28.18 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $83.18
| Facility | | $35.48 | $46.77 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $40.74
| Professional | | $26.30 | $30.90 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $37.15
| Facility | | $30.90 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $13.18 / $34.67
| Professional | | $11.75 | $13.18 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $30.90 / $56.23
| Professional | | $14.13 | $30.90 | $56.23 |