- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $75.86 / $251.19
| Facility | | $16.98 | $75.86 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $23.44 / $38.02
| Professional | | $12.88 | $23.44 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.72 / $10.72
| Professional | | $10.47 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $25.70 / $34.67
| Facility | | $17.38 | $25.70 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $17.38
| Professional | | $12.88 | $15.49 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $35.48 / $44.67
| Facility | | $17.78 | $35.48 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $18.20 / $24.55
| Professional | | $9.12 | $18.20 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $19.05
| Facility | | $17.38 | $17.38 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Professional | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $27.54 / $47.86
| Facility | | $17.38 | $27.54 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $20.89
| Professional | | $15.49 | $15.49 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $45.71
| Facility | | $19.95 | $25.70 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $17.38
| Professional | | $12.88 | $15.49 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $20.89
| Facility | | $16.60 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $17.78
| Professional | | $7.24 | $7.24 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $8.91 / $30.90
| Professional | | $7.76 | $8.91 | $30.90 |