- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $389.05 / $891.25
| Facility | | $81.28 | $389.05 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $40.74 / $181.97
| Professional | | $10.96 | $40.74 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $44.67 / $128.82
| Professional | | $13.80 | $44.67 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $19.95
| Facility | | $15.85 | $19.05 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $44.67 / $75.86
| Professional | | $35.48 | $44.67 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $117.49 / $186.21
| Facility | | $100.00 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $41.69 / $123.03
| Professional | | $16.60 | $41.69 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $33.88 / $72.44
| Facility | | $11.75 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $97.72
| Professional | | $21.38 | $34.67 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $36.31 / $107.15
| Facility | | $11.75 | $36.31 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 52 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $245.47
| Professional | | $40.74 | $74.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Facility | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $50.12 / $93.33
| Professional | | $16.60 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $47.86 / $114.82
| Professional | | $16.22 | $47.86 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $114.82 / $114.82
| Facility | | $26.92 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $21.38 / $64.57 / $64.57
| Facility | 52 | $21.38 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $66.07 / $245.47
| Professional | | $16.60 | $66.07 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $125.89
| Professional | | $38.90 | $38.90 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $93.33 / $251.19
| Professional | | $40.74 | $93.33 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $42.66 / $125.89
| Professional | | $13.80 | $42.66 | $125.89 |