- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $75.86 / $208.93
| Facility | | $22.91 | $75.86 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $74.13
| Professional | | $14.13 | $18.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $13.49
| Professional | | $11.75 | $11.75 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $44.67 / $97.72
| Facility | | $10.96 | $44.67 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $16.98 / $54.95
| Professional | | $9.55 | $16.98 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $114.82 / $309.03
| Facility | | $43.65 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $63.10
| Professional | | $15.49 | $21.88 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $33.88 / $70.79
| Facility | | $14.79 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $22.39 / $48.98
| Professional | | $11.48 | $22.39 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $19.50 / $30.90
| Professional | | $17.38 | $19.50 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.50 / $43.65
| Professional | | $15.49 | $19.50 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $23.44
| Professional | | $11.48 | $11.48 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $23.44 / $54.95
| Facility | | $16.22 | $23.44 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $48.98
| Professional | | $11.48 | $17.78 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.05 / $29.51
| Professional | | $15.49 | $19.05 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $13.18 / $19.50
| Facility | | $8.71 | $13.18 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.75 / $40.74
| Professional | | $8.13 | $11.75 | $40.74 |