- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $177.83
| Facility | | $33.11 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $79.43
| Professional | | $15.14 | $19.05 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $54.95 / $117.49
| Facility | | $10.96 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $17.38 / $46.77
| Professional | | $9.33 | $17.38 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $97.72 / $263.03
| Facility | | $42.66 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $18.62 / $60.26
| Professional | | $13.18 | $18.62 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $41.69 / $79.43
| Facility | | $16.60 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $21.38 / $43.65
| Professional | | $12.30 | $21.38 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $38.02
| Professional | | $17.78 | $23.44 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.44 / $53.70
| Professional | | $19.05 | $23.44 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $28.18
| Professional | | $14.13 | $14.13 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $27.54 / $66.07
| Facility | | $17.38 | $27.54 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $46.77
| Professional | | $12.30 | $17.78 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $39.81
| Professional | | $19.05 | $23.99 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.13 / $23.44
| Facility | | $10.72 | $14.13 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.13 / $44.67
| Professional | | $9.55 | $14.13 | $44.67 |