- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $87.10 / $181.97
| Facility | | $28.84 | $87.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $61.66
| Professional | | $15.14 | $19.05 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $36.31
| Professional | | $13.18 | $13.18 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $100.00 / $630.96
| Facility | | $37.15 | $100.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $5,011.87
| Facility | | $117.49 | $154.88 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $20.89
| Professional | | $16.98 | $16.98 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $33.11 / $74.13
| Facility | | $15.85 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $28.18 / $53.70
| Professional | | $12.88 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.88 / $31.62
| Professional | | $10.23 | $12.88 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $38.02
| Professional | | $21.38 | $24.55 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $56.23 / $117.49
| Facility | | $31.62 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $16.60 / $20.89
| Professional | | $13.18 | $16.60 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $100.00 / $630.96
| Facility | | $39.81 | $100.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $34.67 / $109.65
| Facility | | $15.49 | $34.67 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $33.88
| Professional | | $15.85 | $18.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $23.44 / $32.36
| Facility | | $14.45 | $23.44 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $23.44 / $32.36
| Professional | | $12.30 | $23.44 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.88 / $26.30
| Facility | | $12.88 | $21.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $38.02
| Professional | | $10.00 | $16.22 | $38.02 |