- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $83.18 / $346.74
| Facility | | $20.42 | $83.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $37.15
| Professional | | $14.13 | $16.98 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $91.20 / $1,096.48
| Facility | | $28.84 | $91.20 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $5,011.87
| Facility | | $102.33 | $134.90 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $18.20
| Professional | | $15.14 | $15.14 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $29.51 / $66.07
| Facility | | $13.80 | $29.51 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $25.12 / $46.77
| Professional | | $11.48 | $25.12 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.50 / $28.18
| Professional | | $9.12 | $19.50 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $21.38 / $33.88
| Professional | | $19.50 | $21.38 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $60.26 / $158.49
| Facility | | $33.88 | $60.26 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $15.14
| Professional | | $11.48 | $11.48 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $75.86 / $181.97
| Facility | | $22.39 | $75.86 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $29.51 / $69.18
| Facility | | $15.49 | $29.51 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $23.99
| Professional | | $14.13 | $15.85 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $20.89
| Facility | | $16.22 | $16.22 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $83.18
| Professional | | $14.13 | $18.62 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $19.50 / $23.44
| Facility | | $11.48 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.45 / $33.88
| Professional | | $8.71 | $14.45 | $33.88 |