- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $66.07 / $257.04
| Facility | | $25.70 | $66.07 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $63.10
| Professional | | $19.05 | $25.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.62 / $42.66
| Professional | | $13.49 | $18.62 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $50.12
| Facility | | $25.12 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $16.60 / $35.48
| Professional | | $13.18 | $16.60 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Facility | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $33.88
| Facility | | $18.62 | $28.84 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $37.15
| Professional | | $17.78 | $26.92 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $35.48 / $112.20
| Facility | | $17.78 | $35.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $52.48
| Professional | | $13.49 | $18.20 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $85.11 / $281.84
| Facility | | $33.88 | $85.11 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $17.38 / $43.65
| Professional | | $13.49 | $17.38 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $22.39 / $33.88
| Professional | | $15.14 | $22.39 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Facility | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $54.95
| Professional | | $19.05 | $28.84 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $26.92 / $40.74
| Facility | | $11.48 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $29.51
| Professional | | $11.48 | $16.22 | $29.51 |