- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $407.38 / $724.44
| Facility | | $93.33 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $104.71 / $316.23
| Professional | | $58.88 | $104.71 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $37.15 / $141.25
| Professional | | $35.48 | $37.15 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $302.00 / $549.54
| Facility | | $117.49 | $302.00 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $89.13 / $89.13
| Professional | | $33.88 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $117.49 / $194.98
| Professional | | $39.81 | $117.49 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $36.31
| Facility | | $35.48 | $35.48 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $269.15 / $537.03
| Facility | | $112.20 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $194.98
| Professional | | $60.26 | $109.65 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $812.83 / $1,071.52
| Professional | | $154.88 | $812.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $123.03 / $436.52
| Facility | | $44.67 | $123.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $218.78
| Professional | | $54.95 | $95.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $43.65 / $60.26
| Professional | | $16.22 | $43.65 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,122.02
| Facility | | $1,047.13 | $1,047.13 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $83.18
| Professional | | $41.69 | $53.70 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $125.89 / $407.38
| Facility | | $42.66 | $125.89 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $109.65 / $190.55
| Professional | | $57.54 | $109.65 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $117.49
| Facility | | $44.67 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $147.91
| Professional | | $60.26 | $85.11 | $147.91 |