- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $263.03
| Facility | | $89.13 | $165.96 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $162.18
| Professional | | $48.98 | $74.13 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $229.09
| Facility | | $89.13 | $89.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $128.82
| Professional | | $35.48 | $35.48 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $89.13
| Facility | | $52.48 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $89.13
| Professional | | $48.98 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $190.55 / $316.23
| Facility | | $85.11 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $120.23 / $426.58
| Professional | | $53.70 | $120.23 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $331.13
| Facility | | $102.33 | $194.98 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $165.96
| Professional | | $61.66 | $79.43 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $158.49
| Professional | | $70.79 | $83.18 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $50,118.72
| Facility | | $114.82 | $165.96 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $91.20
| Professional | | $89.13 | $89.13 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $109.65
| Facility | | $79.43 | $89.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $74.13 / $213.80
| Professional | | $37.15 | $74.13 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $81.28 / $93.33
| Facility | | $74.13 | $81.28 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $208.93
| Professional | | $70.79 | $83.18 | $208.93 |