- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $36.31
| Facility | | $20.89 | $27.54 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $57.54
| Professional | | $21.88 | $34.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $57.54
| Professional | | $29.51 | $39.81 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $41.69
| Professional | | $32.36 | $32.36 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $70.79
| Professional | | $27.54 | $40.74 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $48.98
| Professional | | $27.54 | $38.02 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $57.54
| Professional | | $38.02 | $47.86 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $67.61
| Facility | | $28.84 | $43.65 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $25.70
| Professional | | $12.88 | $12.88 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $64.57
| Facility | | $29.51 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $45.71 / $69.18
| Professional | | $35.48 | $45.71 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $1,096.48
| Facility | | $28.18 | $28.18 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $63.10
| Professional | | $26.92 | $39.81 | $63.10 |