- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $67.61 / $208.93
| Facility | | $22.91 | $67.61 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.62 / $75.86
| Professional | | $15.14 | $18.62 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $12.59
| Professional | | $9.55 | $9.55 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $47.86 / $104.71
| Facility | | $11.75 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $18.20 / $60.26
| Professional | | $10.23 | $18.20 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $123.03 / $331.13
| Facility | | $46.77 | $123.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $67.61
| Professional | | $16.60 | $23.44 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $36.31 / $75.86
| Facility | | $15.85 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $23.99 / $47.86
| Professional | | $12.30 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $20.89 / $33.11
| Professional | | $18.20 | $20.89 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $46.77
| Professional | | $16.60 | $20.89 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $19.50 / $36.31
| Professional | | $17.78 | $19.50 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $24.55
| Professional | | $12.30 | $12.30 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $61.66
| Facility | | $16.98 | $24.55 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $19.05 / $52.48
| Professional | | $12.30 | $19.05 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $35.48
| Professional | | $16.60 | $20.89 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $14.13 / $20.89
| Facility | | $9.33 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.30 / $42.66
| Professional | | $8.71 | $12.30 | $42.66 |