- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $19.05 / $20.89
| Professional | | $8.91 | $19.05 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $26.30
| Professional | | $22.39 | $22.39 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $102.33
| Facility | | $63.10 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $33.88 / $45.71
| Professional | | $11.48 | $33.88 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $19.95 / $23.44
| Facility | | $17.38 | $19.95 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $28.18
| Professional | | $21.38 | $25.70 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $22.91 / $36.31
| Facility | | $17.38 | $22.91 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $21.88
| Professional | | $9.12 | $11.75 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $70.79
| Professional | | $32.36 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $36.31
| Professional | | $17.38 | $23.44 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $70.79
| Professional | | $23.99 | $35.48 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $147.91
| Facility | | $47.86 | $47.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $104.71 / $213.80
| Professional | | $11.22 | $104.71 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $17.78
| Professional | | $9.12 | $11.75 | $17.78 |