- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $281.84 / $338.84
| Facility | | $7.94 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $14.13
| Professional | | $7.08 | $7.08 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $125.89 / $125.89
| Facility | | $7.59 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $141.25
| Professional | | $125.89 | $125.89 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $169.82 / $562.34
| Facility | | $28.84 | $169.82 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $16.60 / $380.19
| Facility | | $8.71 | $16.60 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.79 / $20.42
| Professional | | $8.71 | $14.79 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $33.11 / $75.86
| Professional | | $7.94 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $8.13
| Facility | | $7.08 | $7.94 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.59 / $10.96
| Facility | | $6.46 | $7.59 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $7.76
| Professional | | $7.59 | $7.59 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $7.59 / $125.89
| Facility | | $6.92 | $7.59 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $125.89 / $141.25
| Professional | | $123.03 | $125.89 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $102.33 / $102.33
| Facility | | $7.59 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $125.89 / $125.89
| Professional | | $7.59 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $154.88 / $295.12
| Professional | | $134.90 | $154.88 | $295.12 |