- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $158.49 / $323.59
| Facility | | $56.23 | $158.49 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $190.55
| Professional | | $20.89 | $26.92 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $67.61 / $144.54
| Facility | | $16.60 | $67.61 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $25.12 / $81.28
| Professional | | $14.13 | $25.12 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $169.82 / $457.09
| Facility | | $56.23 | $169.82 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $93.33
| Professional | | $22.91 | $33.11 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $50.12 / $104.71
| Facility | | $21.88 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $33.11 / $72.44
| Professional | | $17.38 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.84 / $45.71
| Professional | | $25.70 | $28.84 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $66.07
| Professional | | $22.91 | $28.84 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $177.83
| Facility | | $138.04 | $138.04 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $28.84
| Professional | | $14.45 | $14.45 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $83.18
| Facility | | $23.99 | $34.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $72.44
| Professional | | $17.38 | $26.30 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $29.51 / $48.98
| Professional | | $22.91 | $29.51 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $28.84
| Facility | | $12.88 | $19.95 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $58.88
| Professional | | $12.02 | $17.38 | $58.88 |