- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $57.54
| Facility | | $28.18 | $50.12 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $48.98
| Professional | | $18.62 | $25.12 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $104.71
| Facility | | $29.51 | $29.51 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $26.30 / $51.29
| Professional | | $11.48 | $26.30 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $22.91 / $26.30
| Facility | | $21.88 | $22.91 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $30.90
| Professional | | $20.89 | $27.54 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $57.54 / $112.20
| Facility | | $26.30 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.44 / $81.28
| Professional | | $12.59 | $23.44 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $151.36
| Facility | | $25.70 | $35.48 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $17.78 / $181.97
| Professional | | $12.59 | $17.78 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $29.51 / $35.48
| Facility | | $11.48 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $17.78 / $39.81
| Professional | | $12.59 | $17.78 | $39.81 |