- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $125.89
| Facility | | $27.54 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $19.95 / $81.28
| Professional | | $7.94 | $19.95 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $93.33
| Facility | | $30.20 | $40.74 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.05 / $20.42
| Professional | | $13.49 | $19.05 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Facility | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $23.44 / $29.51
| Professional | | $14.13 | $23.44 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $24.55 / $158.49
| Facility | | $8.13 | $24.55 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.41 / $22.91
| Professional | | $5.62 | $7.41 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $25.70
| Professional | | $15.14 | $15.14 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Facility | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $416.87 / $1,174.90
| Facility | | $354.81 | $416.87 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.41 / $16.60
| Facility | | $5.25 | $7.41 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.41 / $13.49
| Professional | | $7.08 | $7.41 | $13.49 |