- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $79.43 / $208.93
| Facility | | $32.36 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.88 / $58.88
| Professional | | $24.55 | $33.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $138.04 / $245.47
| Facility | | $52.48 | $138.04 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $39.81 / $58.88
| Professional | | $5.01 | $39.81 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $79.43
| Facility | | $42.66 | $42.66 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $97.72 / $223.87
| Facility | | $50.12 | $97.72 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $89.13
| Professional | | $24.55 | $33.11 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $263.03
| Facility | | $204.17 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $371.54
| Professional | | $323.59 | $323.59 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $131.83
| Facility | | $32.36 | $51.29 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $38.90 / $67.61
| Professional | | $22.39 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $43.65
| Professional | | $36.31 | $36.31 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $91.20
| Professional | | $41.69 | $46.77 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $141.25
| Facility | | $33.88 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $87.10
| Professional | | $24.55 | $40.74 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $42.66 / $51.29
| Facility | | $19.95 | $42.66 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $47.86
| Professional | | $17.78 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $29.51 / $42.66
| Professional | | $16.60 | $29.51 | $42.66 |