- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $75.86 / $177.83
| Facility | | $27.54 | $75.86 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $39.81
| Professional | | $19.05 | $22.91 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $181.97 / $5,011.87
| Facility | | $138.04 | $181.97 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $22.91
| Professional | | $20.42 | $20.42 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $39.81 / $89.13
| Facility | | $18.62 | $39.81 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.88 / $63.10
| Professional | | $15.14 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $26.30 / $38.02
| Professional | | $12.30 | $26.30 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Facility | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $28.84 / $45.71
| Professional | | $26.30 | $28.84 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $169.82
| Facility | | $54.95 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $22.39
| Professional | | $15.49 | $15.49 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $93.33
| Facility | | $21.88 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $21.88 / $38.90
| Professional | | $19.05 | $21.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $26.30
| Facility | | $23.99 | $23.99 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $23.99 / $37.15
| Professional | | $22.91 | $23.99 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.30 / $31.62
| Facility | | $15.14 | $26.30 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $45.71
| Professional | | $11.75 | $17.38 | $45.71 |