- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $208.93
| Facility | | $37.15 | $50.12 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $30.20 / $107.15
| Professional | | $20.42 | $30.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $41.69
| Professional | | $23.44 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $54.95
| Professional | | $25.12 | $38.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $69.18
| Professional | | $22.91 | $36.31 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $46.77
| Facility | | $19.95 | $26.92 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $47.86
| Professional | | $19.95 | $27.54 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $32.36 / $33.11
| Professional | | $13.18 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $42.66
| Facility | | $30.20 | $40.74 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.84 / $28.84
| Facility | | $28.18 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $58.88
| Professional | | $28.18 | $39.81 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $52.48
| Professional | | $25.12 | $37.15 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Facility | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.88 / $63.10
| Professional | | $24.55 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $22.91 / $42.66
| Professional | | $20.89 | $22.91 | $42.66 |