- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.84 / $281.84
| Facility | | $28.18 | $28.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $28.84
| Professional | | $19.05 | $23.99 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $933.25
| Facility | | $602.56 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $22.91
| Professional | | $13.80 | $13.80 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $29.51 / $58.88
| Professional | | $26.92 | $29.51 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $52.48 / $131.83
| Facility | | $1.48 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $15.85 / $38.90
| Professional | | $10.23 | $15.85 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $47.86
| Professional | | $22.91 | $28.84 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $28.84 / $44.67
| Facility | | $12.30 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $32.36
| Professional | | $12.30 | $12.30 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $70.79
| Facility | | $16.98 | $25.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $77.62
| Professional | | $17.78 | $25.70 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $144.54 / $173.78
| Facility | | $12.88 | $144.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $15.14 / $22.39
| Professional | | $8.71 | $15.14 | $22.39 |