- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $41.69 / $70.79
| Facility | | $15.14 | $41.69 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.30 / $30.90
| Professional | | $8.91 | $12.30 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $5,011.87
| Facility | | $58.88 | $77.62 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Professional | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $23.44 / $54.95
| Facility | | $10.96 | $23.44 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $17.78 / $28.84
| Professional | | $7.24 | $17.78 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.49 / $23.44
| Professional | | $7.59 | $13.49 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $16.22
| Facility | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $28.18
| Professional | | $11.48 | $16.22 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $27.54 / $28.18
| Facility | | $26.30 | $27.54 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $28.84 / $54.95
| Facility | | $12.88 | $28.84 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $19.05
| Professional | | $8.91 | $12.02 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $1,047.13
| Facility | | $616.60 | $645.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $9.33 / $16.22
| Facility | | $5.89 | $9.33 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $12.59 / $17.38
| Professional | | $6.61 | $12.59 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $16.22 / $19.50
| Facility | | $7.94 | $16.22 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $10.00 / $23.99
| Professional | | $6.76 | $10.00 | $23.99 |