- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $109.65 / $309.03
| Facility | | $47.86 | $109.65 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $93.33
| Professional | | $23.99 | $41.69 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $114.82
| Facility | | $32.36 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $40.74 / $309.03
| Professional | | $20.89 | $40.74 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $138.04
| Facility | | $69.18 | $107.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $60.26 / $134.90
| Facility | | $28.18 | $60.26 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $95.50
| Professional | | $20.89 | $38.02 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $346.74 / $8,511.38
| Facility | | $50.12 | $346.74 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $58.88
| Professional | | $50.12 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $64.57
| Professional | | $35.48 | $35.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $102.33 / $162.18
| Facility | | $41.69 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $114.82
| Facility | | $32.36 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $40.74 / $309.03
| Professional | | $20.89 | $40.74 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $66.07
| Facility | | $26.92 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $54.95
| Professional | | $35.48 | $50.12 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $57.54
| Facility | | $21.88 | $35.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $70.79
| Professional | | $20.89 | $35.48 | $70.79 |