- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $251.19 / $524.81
| Facility | | $52.48 | $251.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $138.04
| Professional | | $25.70 | $50.12 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $33.88
| Professional | | $28.84 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $32.36
| Facility | | $23.44 | $23.44 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $22.39 / $22.39
| Professional | | $15.14 | $22.39 | $22.39 |
- 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
- $21.88 / $22.39 / $33.88
| Professional | | $21.88 | $22.39 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $85.11
| Facility | | $26.92 | $38.02 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $41.69 / $66.07
| Professional | | $19.05 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $69.18 / $81.28
| Professional | | $33.11 | $69.18 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $42.66 / $46.77
| Facility | | $10.47 | $42.66 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $40.74
| Professional | | $12.02 | $21.88 | $40.74 |