- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $87.10
| Facility | | $28.84 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $22.91 / $42.66
| Professional | | $20.89 | $22.91 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $74.13
| Facility | | $28.84 | $28.84 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.79 / $67.61
| Professional | | $14.13 | $14.79 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.84 / $28.84
| Facility | | $17.38 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $28.84
| Professional | | $20.89 | $28.84 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $63.10 / $309.03
| Facility | | $28.18 | $63.10 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $41.69 / $190.55
| Professional | | $19.50 | $41.69 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $33.11 / $79.43
| Facility | | $17.78 | $33.11 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $56.23
| Professional | | $13.49 | $19.95 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.84 / $38.02
| Professional | | $25.70 | $28.84 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $50,118.72
| Facility | | $36.31 | $54.95 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $46.77
| Facility | | $21.88 | $34.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $64.57
| Professional | | $12.02 | $21.88 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $69.18
| Facility | | $24.55 | $28.84 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $93.33
| Professional | | $24.55 | $30.20 | $93.33 |