- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $239.88
| Facility | | $77.62 | $144.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $263.03
| Professional | | $69.18 | $114.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $275.42
| Professional | | $81.28 | $107.15 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $120.23
| Facility | | $27.54 | $27.54 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $120.23 / $147.91
| Professional | | $27.54 | $120.23 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $1,174.90
| Facility | | $204.17 | $302.00 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $194.98 / $691.83
| Professional | | $79.43 | $194.98 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $302.00
| Facility | | $72.44 | $112.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $147.91 / $223.87
| Professional | | $107.15 | $147.91 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $102.33 / $186.21
| Professional | | $42.66 | $102.33 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $165.96 / $53,703.18
| Facility | | $83.18 | $165.96 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $144.54 / $154.88
| Professional | | $123.03 | $144.54 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $977.24
| Facility | | $363.08 | $851.14 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $302.00
| Professional | | $89.13 | $134.90 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $72.44 / $398.11
| Facility | | $35.48 | $72.44 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $323.59
| Professional | | $79.43 | $125.89 | $323.59 |