- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $199.53
| Facility | | $25.12 | $38.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $47.86
| Professional | | $10.96 | $19.05 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $25.12 / $128.82
| Professional | | $14.79 | $25.12 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $91.20
| Facility | | $48.98 | $56.23 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $74.13 / $91.20
| Professional | | $26.92 | $74.13 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $107.15
| Facility | | $16.60 | $25.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $52.48
| Professional | | $37.15 | $40.74 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $107.15
| Facility | | $16.22 | $24.55 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $61.66 / $645.65
| Professional | | $17.38 | $61.66 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $123.03
| Professional | | $32.36 | $33.11 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $190.55
| Facility | | $22.39 | $22.39 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $47.86 / $239.88
| Professional | | $20.89 | $47.86 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $53.70 / $72.44
| Professional | | $30.20 | $53.70 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $331.13 / $331.13
| Facility | | $100.00 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $288.40 / $645.65
| Professional | | $32.36 | $288.40 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $107.15 / $128.82
| Professional | | $48.98 | $107.15 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $38.90 / $141.25
| Professional | | $15.85 | $38.90 | $141.25 |