- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $204.17 / $562.34
| Facility | | $72.44 | $204.17 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $87.10 / $165.96
| Professional | | $67.61 | $87.10 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $371.54 / $602.56
| Facility | | $141.25 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $134.90 / $147.91
| Professional | | $5.01 | $134.90 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $109.65
| Facility | | $79.43 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $239.88 / $549.54
| Facility | | $97.72 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $199.53
| Professional | | $56.23 | $104.71 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $812.83 / $812.83
| Professional | | $549.54 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $416.87
| Facility | | $75.86 | $112.20 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $173.78
| Professional | | $57.54 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $109.65
| Professional | | $91.20 | $91.20 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $117.49 / $234.42
| Professional | | $109.65 | $117.49 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $426.58
| Facility | | $79.43 | $125.89 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $199.53
| Professional | | $61.66 | $117.49 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $109.65 / $131.83
| Facility | | $51.29 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $125.89
| Professional | | $45.71 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $75.86 / $109.65
| Professional | | $42.66 | $75.86 | $109.65 |