- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $229.09 / $630.96
| Facility | | $85.11 | $229.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $97.72 / $169.82
| Professional | | $75.86 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $85.11
| Professional | | $60.26 | $74.13 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $398.11 / $707.95
| Facility | | $162.18 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $67.61 / $165.96
| Professional | | $5.01 | $67.61 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $169.82
| Professional | | $85.11 | $120.23 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $169.82
| Facility | | $123.03 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $275.42 / $616.60
| Facility | | $117.49 | $275.42 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $251.19
| Professional | | $69.18 | $83.18 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $912.01
| Facility | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $912.01 / $912.01
| Professional | | $602.56 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $467.74
| Facility | | $85.11 | $128.82 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $186.21
| Professional | | $64.57 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $123.03
| Professional | | $102.33 | $102.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,570.40
| Facility | | $2,344.23 | $2,344.23 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $131.83 / $257.04
| Professional | | $123.03 | $131.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $512.86
| Facility | | $89.13 | $141.25 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $234.42
| Professional | | $69.18 | $112.20 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $123.03 / $144.54
| Facility | | $56.23 | $123.03 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $141.25
| Professional | | $51.29 | $69.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $123.03
| Professional | | $47.86 | $83.18 | $123.03 |