- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $47.86 / $131.83
| Facility | | $19.05 | $47.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $30.90
| Professional | | $15.14 | $19.95 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $81.28 / $144.54
| Facility | | $35.48 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $14.13 / $22.91
| Professional | | $5.01 | $14.13 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $28.84
| Facility | | $25.70 | $25.70 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $134.90
| Facility | | $28.84 | $56.23 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $41.69
| Professional | | $14.13 | $18.20 | $41.69 |
- 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
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $63.10
| Facility | | $19.05 | $25.70 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $23.99 / $44.67
| Professional | | $15.14 | $23.99 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $21.38 / $21.38
| Professional | | $19.05 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $74.13
| Facility | | $19.95 | $25.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $41.69
| Professional | | $14.13 | $18.20 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $25.70 / $30.90
| Facility | | $11.48 | $25.70 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $25.70
| Professional | | $10.72 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.18 / $25.70
| Professional | | $10.00 | $13.18 | $25.70 |