- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $61.66
| Facility | | $19.05 | $23.99 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $42.66
| Professional | | $19.05 | $23.99 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $52.48
| Facility | | $50.12 | $50.12 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $54.95
| Professional | | $26.30 | $26.30 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $33.88
| Professional | | $25.70 | $25.70 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $29.51
| Facility | | $19.50 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $29.51
| Professional | | $21.88 | $21.88 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $69.18
| Professional | | $37.15 | $50.12 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $48.98
| Professional | | $26.30 | $32.36 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $32.36 / $61.66
| Facility | | $19.50 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $61.66
| Professional | | $26.92 | $26.92 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $144.54
| Facility | | $28.18 | $41.69 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $144.54
| Professional | | $28.18 | $41.69 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $23.44 / $50.12
| Facility | | $15.14 | $23.44 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $24.55 / $39.81
| Professional | | $22.39 | $24.55 | $39.81 |