- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $144.54
| Facility | | $21.88 | $43.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $41.69
| Professional | | $12.88 | $19.95 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $43.65
| Facility | | $22.39 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $28.84
| Professional | | $18.62 | $21.88 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $48.98 / $64.57
| Facility | | $22.91 | $48.98 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.44 / $30.20
| Professional | | $12.59 | $23.44 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $61.66
| Facility | | $21.88 | $28.18 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $64.57
| Professional | | $21.88 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $75.86
| Professional | | $19.50 | $23.44 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $44.67
| Facility | | $21.88 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $26.30
| Professional | | $21.88 | $21.88 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $60.26
| Facility | | $21.88 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $26.30
| Professional | | $19.95 | $19.95 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $57.54
| Facility | | $25.12 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $28.84
| Professional | | $18.62 | $21.88 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.30 / $26.30
| Facility | | $21.88 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.02 / $26.30
| Professional | | $9.12 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $21.88 / $39.81
| Professional | | $9.77 | $21.88 | $39.81 |