- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $117.49 / $346.74
| Facility | | $25.70 | $117.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $50.12
| Professional | | $16.60 | $21.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $25.70
| Professional | | $10.96 | $15.85 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $147.91
| Facility | | $28.18 | $79.43 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $14.13 / $20.42
| Professional | | $5.01 | $14.13 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $234.42
| Facility | | $23.99 | $38.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $25.70 / $43.65
| Professional | | $19.50 | $25.70 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $138.04
| Facility | | $29.51 | $57.54 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $24.55 / $46.77
| Professional | | $14.45 | $24.55 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $48.98
| Professional | | $21.88 | $33.11 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $54.95 / $281.84
| Facility | | $19.50 | $54.95 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $22.39 / $46.77
| Professional | | $15.49 | $22.39 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $21.88 / $21.88
| Professional | | $19.50 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $75.86
| Facility | | $20.42 | $25.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $24.55 / $45.71
| Professional | | $14.45 | $24.55 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $25.70 / $30.90
| Facility | | $11.48 | $25.70 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $32.36
| Professional | | $10.96 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.49 / $17.78
| Professional | | $10.00 | $13.49 | $17.78 |