- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $141.25 / $263.03
| Facility | | $28.84 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $52.48 / $66.07
| Professional | | $12.88 | $52.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $28.84 / $47.86
| Professional | | $9.77 | $28.84 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $141.25
| Facility | | $30.20 | $44.67 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $31.62
| Professional | | $20.89 | $30.20 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $46.77
| Professional | | $22.39 | $37.15 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $63.10 / $204.17
| Facility | | $21.38 | $63.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.75 / $28.18
| Professional | | $8.13 | $11.75 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $39.81
| Professional | | $23.99 | $23.99 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Facility | | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $331.13 / $724.44
| Facility | | $281.84 | $331.13 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.75 / $25.70
| Facility | | $8.13 | $11.75 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $11.75 / $21.38
| Professional | | $10.96 | $11.75 | $21.38 |