- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Facility | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $32.36
| Professional | | $15.14 | $18.20 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $67.61
| Facility | | $40.74 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $45.71
| Professional | | $30.90 | $38.02 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $85.11 / $134.90
| Facility | | $22.39 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.88 / $38.90
| Professional | | $16.22 | $33.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $47.86
| Facility | | $18.62 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $63.10
| Professional | | $39.81 | $56.23 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $39.81 / $213.80
| Facility | | $18.62 | $39.81 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $48.98
| Professional | | $17.38 | $25.12 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $70.79
| Professional | | $50.12 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $134.90
| Professional | | $40.74 | $61.66 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $81.28 / $245.47
| Facility | | $22.39 | $81.28 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $223.87
| Professional | | $16.22 | $32.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $40.74
| Facility | | $22.39 | $28.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $20.42 / $33.11
| Professional | | $16.22 | $20.42 | $33.11 |