- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $138.04 / $281.84
| Facility | | $48.98 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $169.82
| Professional | | $19.05 | $23.99 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $58.88 / $128.82
| Facility | | $14.45 | $58.88 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $21.88 / $70.79
| Professional | | $12.30 | $21.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $147.91 / $398.11
| Facility | | $52.48 | $147.91 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $81.28
| Professional | | $19.95 | $28.84 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $44.67 / $93.33
| Facility | | $19.50 | $44.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $29.51 / $63.10
| Professional | | $14.79 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $25.70 / $40.74
| Professional | | $22.39 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $57.54
| Professional | | $20.42 | $25.70 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $30.90
| Professional | | $15.49 | $15.49 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $77.62
| Facility | | $20.89 | $30.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $23.44 / $63.10
| Professional | | $14.79 | $23.44 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $26.30 / $43.65
| Professional | | $20.42 | $26.30 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $17.38 / $25.70
| Facility | | $11.48 | $17.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $15.14 / $51.29
| Professional | | $10.72 | $15.14 | $51.29 |