- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $26.92
| Facility | | $25.12 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $34.67
| Professional | | $16.98 | $25.12 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $37.15
| Professional | | $18.20 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Professional | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $72.44
| Professional | | $33.11 | $45.71 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $43.65
| Professional | | $29.51 | $29.51 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $57.54
| Facility | | $22.91 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $27.54
| Professional | | $22.39 | $26.92 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $158.49
| Facility | | $29.51 | $37.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $158.49
| Professional | | $29.51 | $37.15 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $20.42 / $33.88
| Professional | | $18.62 | $20.42 | $33.88 |