- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $33.11
| Professional | | $15.85 | $21.88 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $38.02
| Facility | | $31.62 | $31.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $31.62
| Professional | | $29.51 | $29.51 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $30.20
| Facility | | $21.38 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $30.20
| Professional | | $18.62 | $18.62 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $19.50 / $25.12
| Professional | | $17.78 | $19.50 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $33.88 / $56.23
| Facility | | $12.59 | $33.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $31.62
| Facility | | $11.48 | $16.98 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $26.92
| Professional | | $14.13 | $19.05 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $281.84
| Professional | | $194.98 | $194.98 | $281.84 |