- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $72.44 / $120.23
| Professional | | $39.81 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $218.78
| Professional | | $79.43 | $79.43 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $77.62 / $102.33
| Facility | | $11.48 | $77.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $77.62 / $102.33
| Professional | | $11.48 | $77.62 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $109.65
| Professional | | $52.48 | $61.66 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $125.89
| Professional | | $64.57 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $77.62 / $102.33
| Professional | | $72.44 | $77.62 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $46.77 / $81.28
| Facility | | $6.31 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $141.25
| Professional | | $47.86 | $75.86 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $72.44
| Facility | | $70.79 | $70.79 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $102.33
| Professional | | $72.44 | $72.44 | $102.33 |