- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.18
| Facility | | $22.91 | $22.91 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $33.11
| Professional | | $15.14 | $19.95 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $42.66
| Facility | | $21.38 | $21.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $44.67 / $54.95
| Professional | | $21.38 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $63.10
| Professional | | $32.36 | $57.54 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $45.71 / $177.83
| Facility | | $26.30 | $45.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $63.10
| Professional | | $16.98 | $23.44 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $43.65 / $52.48
| Professional | | $41.69 | $43.65 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $63.10
| Professional | | $38.90 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $38.90 / $91.20
| Facility | | $13.18 | $38.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.05 / $36.31
| Professional | | $16.98 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $36.31
| Professional | | $28.84 | $36.31 | $36.31 |