- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $104.71 / $269.15
| Facility | | $42.66 | $104.71 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $83.18
| Professional | | $20.89 | $26.30 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $141.25
| Facility | | $26.92 | $41.69 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $72.44
| Professional | | $17.78 | $29.51 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $72.44 / $104.71
| Facility | | $57.54 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $37.15
| Professional | | $27.54 | $27.54 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $46.77 / $114.82
| Facility | | $22.91 | $46.77 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $34.67 / $77.62
| Professional | | $17.78 | $34.67 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $229.09 / $7,079.46
| Facility | | $33.88 | $229.09 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $50.12
| Professional | | $42.66 | $42.66 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $81.28
| Professional | | $29.51 | $29.51 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $229.09
| Facility | | $34.67 | $43.65 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $141.25
| Facility | | $26.92 | $41.69 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $72.44
| Professional | | $17.78 | $29.51 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $69.18
| Facility | | $26.30 | $35.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $44.67
| Professional | | $26.30 | $30.20 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $29.51 / $43.65
| Facility | | $14.79 | $29.51 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $79.43
| Professional | | $17.78 | $29.51 | $79.43 |