- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $91.20 / $117.49
| Facility | | $33.88 | $91.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $33.88
| Professional | | $15.85 | $20.89 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $218.78
| Facility | | $70.79 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $70.79
| Professional | | $34.67 | $52.48 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $1.95 / $53.70
| Facility | | $0.87 | $1.95 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $20.89 / $38.02
| Professional | | $10.23 | $20.89 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $75.86
| Facility | | $20.89 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $69.18
| Professional | | $22.39 | $35.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $50.12 / $75.86
| Professional | | $39.81 | $50.12 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $41.69
| Facility | | $34.67 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $56.23
| Professional | | $34.67 | $41.69 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $38.90
| Facility | | $27.54 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $75.86
| Professional | | $27.54 | $52.48 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $107.15 / $218.78
| Facility | | $52.48 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $69.18
| Professional | | $38.90 | $52.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $131.83 / $223.87
| Facility | | $34.67 | $131.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $12.59 / $30.20
| Professional | | $8.51 | $12.59 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $26.92
| Professional | | $6.76 | $6.76 | $26.92 |