- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $234.42
| Professional | | $26.92 | $26.92 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $52.48 / $52.48
| Facility | | $46.77 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $54.95 / $61.66
| Professional | | $4.27 | $54.95 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $47.86
| Professional | | $21.38 | $21.38 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $58.88
| Facility | | $54.95 | $54.95 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $58.88
| Professional | | $54.95 | $54.95 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $44.67 / $48.98
| Professional | | $35.48 | $44.67 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $38.90 / $53.70
| Facility | | $4.37 | $38.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $53.70
| Professional | | $5.13 | $5.13 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $44.67 / $61.66
| Facility | | $4.27 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $44.67 / $47.86
| Professional | | $4.27 | $44.67 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $47.86 / $61.66
| Professional | | $4.27 | $47.86 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $19.95 / $34.67
| Facility | | $2.19 | $19.95 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $26.30 / $46.77
| Professional | | $24.55 | $26.30 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |