- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $112.20 / $501.19
| Facility | | $42.66 | $112.20 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $104.71
| Professional | | $32.36 | $38.90 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $36.31
| Professional | | $21.38 | $25.70 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $79.43
| Facility | | $38.90 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $57.54
| Professional | | $21.38 | $26.92 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $60.26
| Facility | | $33.88 | $48.98 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $57.54
| Professional | | $42.66 | $51.29 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $56.23 / $177.83
| Facility | | $45.71 | $56.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.90 / $85.11
| Professional | | $21.88 | $38.90 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $85.11 / $257.04
| Facility | | $27.54 | $85.11 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $107.15
| Professional | | $21.38 | $42.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $52.48
| Professional | | $32.36 | $38.90 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $97.72
| Professional | | $36.31 | $52.48 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $42.66 / $64.57
| Facility | | $38.90 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $72.44
| Professional | | $17.78 | $25.70 | $72.44 |