- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $57.54
| Professional | | $19.50 | $34.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $112.20
| Professional | | $46.77 | $46.77 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $38.02 / $50.12
| Facility | | $5.13 | $38.02 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $38.02 / $50.12
| Professional | | $5.13 | $38.02 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $51.29
| Professional | | $33.11 | $38.90 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $60.26
| Professional | | $33.11 | $38.90 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $48.98
| Professional | | $43.65 | $47.86 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $23.44 / $38.90
| Facility | | $2.88 | $23.44 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $66.07
| Professional | | $23.99 | $36.31 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $47.86
| Facility | | $42.66 | $43.65 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $45.71 / $47.86
| Professional | | $43.65 | $45.71 | $47.86 |