- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $77.62 / $446.68
| Facility | | $31.62 | $77.62 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $22.91 / $141.25
| Professional | | $17.38 | $22.91 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $117.49 / $2,511.89
| Facility | | $37.15 | $117.49 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $5,011.87
| Facility | | $141.25 | $186.21 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $25.12
| Professional | | $20.89 | $20.89 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $40.74 / $91.20
| Facility | | $19.50 | $40.74 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $38.02 / $69.18
| Professional | | $15.85 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $38.90
| Professional | | $12.59 | $15.85 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Facility | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $46.77
| Professional | | $22.91 | $30.20 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $69.18 / $165.96
| Facility | | $36.31 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $22.91
| Professional | | $16.22 | $16.22 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $97.72 / $229.09
| Facility | | $30.90 | $97.72 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $91.20
| Facility | | $21.88 | $40.74 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $39.81
| Professional | | $18.20 | $21.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $58.88
| Facility | | $9.12 | $12.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $26.30 / $58.88
| Professional | | $9.12 | $26.30 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $32.36
| Facility | | $15.85 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $46.77
| Professional | | $12.02 | $19.95 | $46.77 |