- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $28.18
| Facility | | $20.89 | $25.12 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $47.86
| Professional | | $22.39 | $28.18 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $58.88
| Professional | | $25.70 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $245.47
| Professional | | $173.78 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $81.28
| Facility | | $25.70 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.18 / $52.48
| Professional | | $24.55 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $30.20
| Professional | | $21.38 | $26.30 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $199.53
| Professional | | $147.91 | $165.96 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $83.18
| Facility | | $25.70 | $34.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $54.95
| Professional | | $25.70 | $34.67 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Facility | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $50.12
| Professional | | $23.99 | $31.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $43.65
| Professional | | $30.90 | $34.67 | $43.65 |