- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $77.62 / $223.87
| Facility | | $30.90 | $77.62 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $52.48
| Professional | | $22.39 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $25.70
| Professional | | $19.95 | $19.95 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $128.82 / $218.78
| Facility | | $48.98 | $128.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $22.91 / $40.74
| Professional | | $5.01 | $22.91 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $63.10
| Professional | | $25.12 | $41.69 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $41.69
| Facility | | $28.84 | $41.69 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $77.62 / $186.21
| Facility | | $29.51 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $63.10
| Professional | | $15.85 | $21.38 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $275.42
| Facility | | $199.53 | $199.53 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $95.50
| Facility | | $30.20 | $41.69 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $66.07
| Professional | | $25.12 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $35.48 / $35.48
| Professional | | $31.62 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $117.49
| Facility | | $29.51 | $41.69 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $52.48
| Professional | | $15.85 | $21.38 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $41.69 / $50.12
| Facility | | $15.14 | $41.69 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $17.38 / $33.11
| Professional | | $14.45 | $17.38 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $21.88 / $28.84
| Professional | | $16.22 | $21.88 | $28.84 |