- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $37.15
| Facility | | $33.88 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $47.86
| Professional | | $19.05 | $33.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $61.66
| Professional | | $29.51 | $29.51 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $38.90
| Professional | | $30.90 | $30.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $56.23 / $79.43
| Professional | | $42.66 | $56.23 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $37.15
| Professional | | $28.18 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $40.74 / $66.07
| Facility | | $23.99 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $36.31
| Professional | | $30.20 | $33.88 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $162.18
| Facility | | $37.15 | $47.86 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $162.18
| Professional | | $37.15 | $47.86 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $39.81
| Facility | | $17.38 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $27.54 / $45.71
| Professional | | $25.12 | $27.54 | $45.71 |