- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $85.11 / $162.18
| Facility | | $19.50 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $17.38 / $34.67
| Professional | | $12.59 | $17.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $13.49
| Professional | | $8.71 | $11.48 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $66.07 / $114.82
| Facility | | $25.70 | $66.07 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.72 / $12.02
| Professional | | $5.01 | $10.72 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $30.90 / $112.20
| Facility | | $17.78 | $30.90 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $30.90
| Professional | | $13.49 | $19.50 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $20.42
| Facility | | $19.50 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $97.72
| Facility | | $21.88 | $40.74 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $33.11
| Professional | | $10.96 | $14.13 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.18 / $32.36
| Professional | | $17.38 | $28.18 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $24.55 / $117.49
| Facility | | $14.79 | $24.55 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $17.38 / $34.67
| Professional | | $10.96 | $17.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $16.22 / $16.22
| Professional | | $14.45 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $467.74
| Facility | | $263.03 | $426.58 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.50 / $56.23
| Facility | | $15.49 | $19.50 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $32.36
| Professional | | $10.96 | $14.13 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $19.50 / $23.44
| Facility | | $8.71 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $26.92
| Professional | | $8.13 | $11.48 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.00 / $19.50
| Professional | | $7.59 | $10.00 | $19.50 |