- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $112.20
| Facility | | $22.91 | $34.67 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $61.66
| Professional | | $16.98 | $25.12 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $36.31
| Facility | | $32.36 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $41.69
| Professional | | $32.36 | $32.36 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $24.55 / $24.55
| Facility | | $13.80 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $24.55
| Professional | | $18.20 | $18.20 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $51.29 / $104.71
| Facility | | $21.38 | $51.29 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $44.67 / $79.43
| Professional | | $21.38 | $44.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.84 / $60.26
| Professional | | $25.70 | $28.84 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $37.15 / $38.02
| Facility | | $36.31 | $37.15 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $74.13
| Facility | | $33.11 | $56.23 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $36.31
| Professional | | $30.90 | $30.90 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $41.69
| Professional | | $32.36 | $32.36 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $56.23 / $56.23
| Facility | | $16.98 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $18.62 / $32.36
| Professional | | $15.85 | $18.62 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $57.54
| Professional | | $26.92 | $32.36 | $57.54 |