- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $93.33 / $95.50
| Facility | | $23.44 | $93.33 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $28.18
| Professional | | $15.85 | $19.95 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $42.66 / $97.72
| Professional | | $22.39 | $42.66 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $66.07 / $77.62
| Facility | | $28.84 | $66.07 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $41.69 / $64.57
| Professional | | $19.05 | $41.69 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.38 / $38.90
| Facility | | $16.98 | $21.38 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $56.23
| Professional | | $26.92 | $40.74 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $21.38 / $45.71
| Facility | | $15.14 | $21.38 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $117.49
| Professional | | $18.62 | $31.62 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $35.48 / $56.23
| Professional | | $16.22 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $63.10
| Professional | | $19.95 | $35.48 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $29.51 / $117.49
| Facility | | $28.18 | $29.51 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $44.67 / $138.04
| Professional | | $15.49 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $27.54
| Professional | | $23.44 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $95.50 / $112.20
| Professional | | $37.15 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $83.18
| Professional | | $16.98 | $32.36 | $83.18 |