- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $66.07 / $245.47
| Facility | | $13.49 | $66.07 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $32.36 / $33.88
| Professional | | $30.90 | $32.36 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $52.48
| Professional | | $31.62 | $31.62 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $48.98 / $74.13
| Professional | | $43.65 | $48.98 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $79.43
| Facility | | $43.65 | $58.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $67.61
| Professional | | $26.92 | $31.62 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Professional | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $51.29
| Facility | | $20.42 | $31.62 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $63.10
| Facility | | $30.20 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $63.10
| Professional | | $30.20 | $38.02 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $69.18
| Facility | | $52.48 | $52.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $31.62 / $40.74
| Professional | | $30.90 | $31.62 | $40.74 |