- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.02 / $38.02
| Professional | | $28.18 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $107.15
| Facility | | $58.88 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $79.43
| Professional | | $50.12 | $58.88 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $288.40
| Facility | | $38.02 | $38.02 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $72.44 / $114.82
| Professional | | $38.02 | $72.44 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $48.98 / $69.18
| Facility | | $19.05 | $48.98 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $69.18 / $269.15
| Facility | | $19.05 | $69.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $56.23
| Professional | | $28.84 | $34.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $30.20 / $58.88
| Professional | | $3.39 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $102.33
| Professional | | $29.51 | $54.95 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $13.80 / $19.05
| Professional | | $7.76 | $13.80 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $117.49 / $275.42
| Facility | | $38.02 | $117.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.02 / $45.71
| Professional | | $32.36 | $38.02 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $22.39 / $44.67
| Facility | | $2.75 | $22.39 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.88 / $58.88
| Professional | | $22.39 | $33.88 | $58.88 |