- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $79.43 / $199.53
| Facility | | $26.30 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.14 / $85.11
| Professional | | $10.00 | $15.14 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.91
| Professional | | $8.13 | $8.13 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $30.90 / $66.07
| Facility | | $7.59 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $11.75 / $37.15
| Professional | | $6.61 | $11.75 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $87.10 / $208.93
| Facility | | $30.20 | $87.10 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $43.65
| Professional | | $10.47 | $15.14 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $23.44 / $48.98
| Facility | | $10.00 | $23.44 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $15.14 / $33.11
| Professional | | $7.94 | $15.14 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $13.18 / $21.38
| Professional | | $11.75 | $13.18 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $13.18 / $30.20
| Professional | | $10.72 | $13.18 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $15.85
| Professional | | $7.94 | $7.94 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $40.74
| Facility | | $11.22 | $15.85 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.30 / $33.11
| Professional | | $7.94 | $12.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $13.49 / $22.39
| Professional | | $10.72 | $13.49 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $9.12 / $13.18
| Facility | | $5.62 | $9.12 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.94 / $27.54
| Professional | | $5.62 | $7.94 | $27.54 |