- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $52.48 / $223.87
| Facility | | $26.30 | $52.48 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $26.30 / $46.77
| Professional | | $25.70 | $26.30 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $30.90
| Facility | | $22.91 | $28.18 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.90 / $32.36
| Professional | | $30.20 | $30.90 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $70.79
| Professional | | $28.18 | $30.90 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $245.47
| Facility | | $25.70 | $43.65 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $575.44
| Professional | | $28.18 | $31.62 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $70.79
| Professional | | $30.90 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $151.36
| Professional | | $43.65 | $70.79 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $51.29
| Facility | | $23.44 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $27.54 / $69.18
| Professional | | $25.70 | $27.54 | $69.18 |