- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $102.33 / $537.03
| Facility | | $34.67 | $102.33 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $72.44 / $95.50
| Professional | | $23.99 | $72.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $35.48 / $69.18
| Professional | | $14.13 | $35.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $190.55
| Facility | | $30.20 | $44.67 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $45.71
| Professional | | $30.20 | $43.65 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $66.07
| Professional | | $31.62 | $52.48 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $93.33 / $208.93
| Facility | | $30.90 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $21.88 / $39.81
| Professional | | $13.80 | $21.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $57.54
| Professional | | $33.88 | $33.88 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $177.83
| Facility | | $81.28 | $95.50 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.60 / $37.15
| Facility | | $11.75 | $16.60 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $16.60 / $30.90
| Professional | | $15.85 | $16.60 | $30.90 |