- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $30.20 / $870.96
| Facility | | $26.92 | $30.20 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $38.02 / $354.81
| Professional | | $15.85 | $38.02 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $35.48 / $46.77
| Professional | | $16.22 | $35.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $35.48 / $63.10
| Professional | | $17.78 | $35.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $64.57
| Professional | | $21.88 | $25.70 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $22.91
| Facility | | $12.88 | $16.98 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $46.77
| Professional | | $27.54 | $35.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $60.26
| Professional | | $21.38 | $41.69 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $40.74 / $57.54
| Professional | | $22.39 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $33.11
| Professional | | $18.62 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $93.33
| Professional | | $37.15 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $30.20 / $56.23
| Professional | | $16.98 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $41.69 / $79.43
| Professional | | $18.62 | $41.69 | $79.43 |