- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $51.29 / $512.86
| Facility | | $21.88 | $51.29 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $34.67
| Professional | | $15.14 | $19.05 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Professional | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $46.77
| Facility | | $23.44 | $34.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $21.38 / $23.44
| Professional | | $17.78 | $21.38 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $52.48 / $69.18
| Facility | | $21.38 | $52.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $25.12 / $33.88
| Professional | | $11.48 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $64.57
| Professional | | $15.14 | $20.89 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $47.86
| Facility | | $23.44 | $23.44 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $38.02 / $64.57
| Facility | | $23.44 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $28.18
| Professional | | $21.38 | $21.38 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $63.10
| Facility | | $26.92 | $35.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $21.38 / $23.44
| Professional | | $17.78 | $21.38 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $28.18
| Facility | | $21.38 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $10.00 / $25.12
| Professional | | $9.55 | $10.00 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $12.30 / $42.66
| Professional | | $10.72 | $12.30 | $42.66 |