- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $102.33
| Professional | | $19.05 | $28.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $29.51 / $63.10
| Professional | | $13.49 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $89.13
| Professional | | $27.54 | $38.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $64.57
| Professional | | $23.44 | $29.51 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $20.89 / $67.61
| Professional | | $12.59 | $20.89 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $30.90 / $41.69
| Professional | | $10.47 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $47.86
| Professional | | $24.55 | $29.51 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $208.93
| Professional | | $151.36 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $48.98
| Facility | | $19.50 | $31.62 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $27.54 / $69.18
| Professional | | $12.59 | $27.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $34.67
| Professional | | $25.70 | $25.70 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $23.99 / $95.50
| Professional | | $14.79 | $23.99 | $95.50 |