- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $75.86 / $239.88
| Facility | | $25.70 | $75.86 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.75 / $67.61
| Professional | | $10.00 | $11.75 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $35.48
| Facility | | $27.54 | $34.67 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $45.71
| Professional | | $6.31 | $6.31 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $13.49
| Facility | | $10.23 | $10.23 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $12.88
| Professional | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $40.74 / $66.07
| Facility | | $35.48 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $18.62 / $39.81
| Professional | | $14.79 | $18.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $27.54 / $46.77
| Facility | | $11.48 | $27.54 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $57.54 / $107.15
| Facility | | $11.48 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $7.76 / $19.95
| Professional | | $4.79 | $7.76 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $32.36 / $64.57
| Professional | | $6.31 | $32.36 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.49 / $19.95
| Facility | | $13.80 | $15.49 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $13.18 / $36.31
| Professional | | $9.55 | $13.18 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $33.11 / $47.86
| Professional | | $17.38 | $33.11 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $524.81
| Facility | | $27.54 | $27.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.51 / $12.59
| Professional | | $6.76 | $8.51 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $186.21
| Professional | | $27.54 | $27.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $85.11 / $186.21
| Professional | | $37.15 | $85.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $11.48 / $15.49
| Facility | | $6.46 | $11.48 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $7.76 / $28.84
| Professional | | $4.90 | $7.76 | $28.84 |