- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $109.65 / $234.42
| Facility | | $36.31 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $138.04
| Professional | | $15.14 | $19.05 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $14.45 / $14.45
| Professional | | $13.80 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $48.98 / $104.71
| Facility | | $12.02 | $48.98 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $18.20 / $63.10
| Professional | | $10.23 | $18.20 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $125.89 / $338.84
| Facility | | $46.77 | $125.89 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $23.99 / $67.61
| Professional | | $16.60 | $23.99 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $36.31 / $75.86
| Facility | | $15.85 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $23.99 / $56.23
| Professional | | $12.30 | $23.99 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $20.89 / $33.11
| Professional | | $18.62 | $20.89 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $46.77
| Professional | | $16.60 | $20.89 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $100.00
| Facility | | $97.72 | $97.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $20.89
| Professional | | $10.47 | $10.47 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $58.88
| Facility | | $17.38 | $25.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $19.05 / $56.23
| Professional | | $12.30 | $19.05 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $31.62
| Professional | | $16.60 | $20.89 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $14.45 / $20.89
| Facility | | $9.33 | $14.45 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $43.65
| Professional | | $8.71 | $12.59 | $43.65 |