- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $120.23 / $426.58
| Facility | | $24.55 | $120.23 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $51.29 / $75.86
| Professional | | $15.85 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $48.98 / $123.03
| Professional | | $19.05 | $48.98 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $16.22 / $28.84
| Professional | | $14.45 | $16.22 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $154.88
| Facility | | $28.84 | $28.84 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $64.57 / $117.49
| Professional | | $19.50 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $97.72 / $138.04
| Professional | | $21.88 | $97.72 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $50.12 / $109.65
| Facility | | $16.98 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $34.67
| Facility | | $18.62 | $23.44 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $123.03
| Professional | | $66.07 | $81.28 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $53.70 / $363.08
| Facility | | $14.13 | $53.70 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $46.77 / $109.65
| Professional | | $16.98 | $46.77 | $109.65 |