- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $125.89 / $223.87
| Facility | | $46.77 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $199.53
| Professional | | $21.88 | $28.84 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $79.43 / $169.82
| Facility | | $16.22 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $32.36 / $67.61
| Professional | | $14.13 | $32.36 | $67.61 |
- 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
- $20.42 / $27.54 / $91.20
| Professional | | $20.42 | $27.54 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $60.26 / $114.82
| Facility | | $23.99 | $60.26 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $37.15 / $66.07
| Professional | | $17.78 | $37.15 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $54.95
| Professional | | $28.18 | $33.88 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $77.62
| Professional | | $27.54 | $33.88 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $87.10
| Facility | | $25.70 | $38.02 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $67.61
| Professional | | $17.78 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $31.62 / $47.86
| Professional | | $27.54 | $31.62 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $33.88
| Facility | | $15.49 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $20.42 / $66.07
| Professional | | $14.45 | $20.42 | $66.07 |