- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $234.42
| Facility | | $77.62 | $147.91 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $63.10 / $114.82
| Professional | | $57.54 | $63.10 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $204.17
| Facility | | $77.62 | $77.62 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $40.74 / $186.21
| Professional | | $38.90 | $40.74 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $77.62 / $77.62
| Facility | | $46.77 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $77.62
| Professional | | $57.54 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $169.82 / $851.14
| Facility | | $75.86 | $169.82 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $138.04 / $524.81
| Professional | | $52.48 | $138.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $89.13 / $213.80
| Facility | | $43.65 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $151.36
| Professional | | $37.15 | $54.95 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $77.62 / $102.33
| Professional | | $67.61 | $77.62 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $50,118.72
| Facility | | $95.50 | $147.91 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $128.82
| Facility | | $58.88 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $173.78
| Professional | | $33.11 | $54.95 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $186.21
| Facility | | $66.07 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $229.09
| Professional | | $66.07 | $81.28 | $229.09 |