- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $95.50
| Facility | | $54.95 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $120.23
| Professional | | $39.81 | $52.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $89.13 / $190.55
| Professional | | $46.77 | $89.13 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $223.87
| Facility | | $120.23 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $141.25 / $158.49
| Professional | | $58.88 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $2,570.40 / $4,786.30
| Facility | | $53.70 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $141.25
| Professional | | $81.28 | $114.82 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $1,202.26 / $2,041.74
| Facility | | $53.70 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $239.88
| Professional | | $50.12 | $89.13 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $891.25 / $2,344.23
| Facility | | $100.00 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $154.88
| Professional | | $64.57 | $117.49 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $112.20 / $154.88
| Professional | | $57.54 | $112.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $1,288.25 / $1,288.25
| Facility | | $120.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $245.47 / $371.54
| Professional | | $66.07 | $245.47 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $257.04
| Professional | | $93.33 | $144.54 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,584.89 / $2,187.76
| Facility | | $1,023.29 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $81.28 / $199.53
| Professional | | $45.71 | $81.28 | $199.53 |