- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $95.50 / $302.00
| Facility | | $32.36 | $95.50 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $44.67
| Professional | | $19.05 | $22.39 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $120.23
| Facility | | $23.44 | $35.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $61.66
| Professional | | $12.59 | $25.70 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $89.13
| Facility | | $50.12 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $32.36
| Professional | | $23.99 | $23.99 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $97.72
| Facility | | $19.95 | $40.74 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $29.51 / $66.07
| Professional | | $15.49 | $29.51 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $208.93 / $7,079.46
| Facility | | $29.51 | $208.93 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $43.65
| Professional | | $37.15 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $69.18
| Professional | | $25.70 | $25.70 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $234.42
| Facility | | $30.20 | $38.02 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $120.23
| Facility | | $23.44 | $35.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $61.66
| Professional | | $12.59 | $25.70 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.84 / $41.69
| Facility | | $22.39 | $28.84 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $38.02
| Professional | | $22.39 | $26.30 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $37.15
| Facility | | $12.88 | $25.70 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $21.38 / $69.18
| Professional | | $10.23 | $21.38 | $69.18 |