- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $239.88
| Facility | | $104.71 | $194.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $112.20
| Professional | | $48.98 | $72.44 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $239.88 / $239.88
| Facility | | $190.55 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $354.81
| Professional | | $35.48 | $35.48 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $457.09
| Facility | | $239.88 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $275.42
| Professional | | $102.33 | $151.36 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $371.54 / $562.34
| Facility | | $97.72 | $371.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $588.84
| Professional | | $524.81 | $524.81 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $309.03
| Facility | | $79.43 | $112.20 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $269.15
| Professional | | $39.81 | $52.48 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $85.11
| Professional | | $43.65 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $104.71 / $251.19
| Facility | | $95.50 | $104.71 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $251.19
| Professional | | $89.13 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $208.93 / $302.00
| Professional | | $154.88 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $416.87 / $416.87
| Facility | | $177.83 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $436.52 / $436.52
| Professional | | $104.71 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $478.63 / $676.08
| Professional | | $257.04 | $478.63 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $70.79 / $190.55
| Facility | | $31.62 | $70.79 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $131.83
| Professional | | $37.15 | $52.48 | $131.83 |