- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $95.50 / $263.03
| Facility | | $35.48 | $95.50 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $56.23
| Professional | | $25.70 | $38.02 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $31.62
| Professional | | $24.55 | $30.20 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $158.49 / $269.15
| Facility | | $60.26 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $28.18 / $50.12
| Professional | | $5.01 | $28.18 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $75.86
| Professional | | $35.48 | $51.29 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $91.20 / $218.78
| Facility | | $39.81 | $91.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $25.70 / $77.62
| Professional | | $9.12 | $25.70 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $128.82
| Facility | | $35.48 | $51.29 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $70.79
| Professional | | $25.70 | $40.74 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $38.02
| Professional | | $32.36 | $33.11 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $141.25
| Facility | | $35.48 | $51.29 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $25.70 / $56.23
| Professional | | $9.12 | $25.70 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $51.29 / $61.66
| Facility | | $18.20 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $21.38 / $30.20
| Professional | | $7.94 | $21.38 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $51.29
| Professional | | $19.95 | $26.30 | $51.29 |