- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $676.08
| Facility | | $87.10 | $194.98 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $331.13
| Professional | | $81.28 | $102.33 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $204.17
| Professional | | $72.44 | $89.13 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $104.71
| Facility | | $43.65 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $104.71 / $147.91
| Professional | | $43.65 | $104.71 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $660.69
| Facility | | $154.88 | $223.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $380.19
| Professional | | $83.18 | $141.25 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $239.88
| Facility | | $57.54 | $91.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $125.89 / $199.53
| Professional | | $100.00 | $125.89 | $199.53 |
- 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
- $75.86 / $128.82 / $229.09
| Professional | | $75.86 | $128.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $112.20 / $181.97
| Facility | | $104.71 | $112.20 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $141.25 / $53,703.18
| Facility | | $70.79 | $141.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $223.87
| Professional | | $120.23 | $144.54 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $181.97 / $213.80
| Facility | | $93.33 | $181.97 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $131.83 / $380.19
| Professional | | $85.11 | $131.83 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $67.61 / $218.78
| Facility | | $25.12 | $67.61 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $125.89 / $251.19
| Professional | | $75.86 | $125.89 | $251.19 |