- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $28.84 / $645.65
| Facility | | $15.14 | $28.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.62 / $33.11
| Professional | | $15.14 | $18.62 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $40.74
| Facility | | $38.02 | $38.02 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $43.65
| Professional | | $20.89 | $20.89 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $24.55
| Facility | | $16.22 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $23.44
| Professional | | $18.20 | $18.20 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $53.70
| Professional | | $28.84 | $38.02 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.70
| Professional | | $25.12 | $25.12 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $45.71
| Facility | | $15.14 | $24.55 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.12 / $47.86
| Professional | | $20.42 | $25.12 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $128.82
| Facility | | $21.38 | $33.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $128.82
| Professional | | $21.38 | $33.11 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $46.77
| Facility | | $11.48 | $16.98 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.62 / $30.90
| Professional | | $16.98 | $18.62 | $30.90 |