- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $8.91
| Facility | | $7.08 | $7.08 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $21.88
| Professional | | $7.08 | $10.96 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $204.17 / $204.17
| Professional | | $125.89 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $14.79 / $28.18
| Facility | | $8.13 | $14.79 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $31.62
| Professional | | $7.08 | $12.02 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $45.71
| Professional | | $24.55 | $37.15 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $15.49 / $28.84
| Facility | | $8.13 | $15.49 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $24.55
| Professional | | $22.39 | $22.39 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.80 / $23.44
| Professional | | $9.12 | $13.80 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $23.99 / $28.18
| Professional | | $19.95 | $23.99 | $28.18 |