- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.30 / $26.30
| Facility | | $21.88 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $28.18
| Professional | | $14.13 | $19.05 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Professional | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $79.43
| Professional | | $60.26 | $66.07 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $27.54 / $61.66
| Facility | | $16.22 | $27.54 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $37.15
| Professional | | $14.13 | $21.88 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $56.23
| Facility | | $47.86 | $47.86 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $28.84 / $61.66
| Facility | | $15.14 | $28.84 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $79.43
| Professional | | $20.89 | $20.89 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $77.62 / $120.23
| Facility | | $42.66 | $77.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $79.43
| Professional | | $58.88 | $60.26 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $18.20 / $30.20
| Facility | | $14.45 | $18.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $30.90
| Professional | | $12.30 | $18.62 | $30.90 |