- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $158.49 / $239.88
| Facility | | $74.13 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $208.93 / $288.40
| Professional | | $154.88 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $138.04 / $446.68
| Professional | | $109.65 | $138.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $316.23
| Facility | | $43.65 | $43.65 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $316.23 / $354.81
| Professional | | $43.65 | $316.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $199.53 / $512.86
| Facility | | $125.89 | $199.53 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $371.54
| Professional | | $66.07 | $114.82 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $257.04
| Facility | | $64.57 | $102.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $204.17
| Professional | | $95.50 | $123.03 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $218.78
| Professional | | $70.79 | $125.89 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $50,118.72 / $75,857.76
| Facility | | $38.90 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $512.86 / $588.84
| Facility | | $263.03 | $512.86 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $199.53 / $758.58
| Professional | | $89.13 | $199.53 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $75.86 / $229.09
| Facility | | $30.20 | $75.86 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $245.47
| Professional | | $74.13 | $125.89 | $245.47 |