- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $102.33
| Facility | | $19.05 | $30.90 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $72.44
| Professional | | $19.50 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $43.65
| Professional | | $20.42 | $27.54 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $93.33
| Professional | | $23.44 | $29.51 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $371.54 / $602.56
| Facility | | $57.54 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $51.29
| Professional | | $20.89 | $29.51 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $22.39 / $48.98
| Professional | | $16.60 | $22.39 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $39.81
| Professional | | $28.18 | $35.48 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $48.98
| Facility | | $20.42 | $28.18 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $380.19
| Facility | | $20.89 | $28.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $380.19
| Professional | | $20.89 | $28.84 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $43.65
| Professional | | $18.20 | $26.30 | $43.65 |