- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $151.36
| Professional | | $16.98 | $21.88 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $37.15
| Facility | | $22.39 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $26.92 / $58.88
| Professional | | $12.88 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.22 / $51.29
| Professional | | $12.02 | $16.22 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $24.55 / $91.20
| Professional | | $13.49 | $24.55 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $30.90
| Professional | | $18.62 | $22.91 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $40.74
| Professional | | $20.89 | $25.12 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $120.23
| Facility | | $109.65 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $177.83
| Professional | | $173.78 | $173.78 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $67.61
| Facility | | $18.62 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $26.92 / $72.44
| Professional | | $13.49 | $26.92 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $275.42
| Professional | | $18.62 | $18.62 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $61.66
| Professional | | $13.80 | $17.38 | $61.66 |