- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $389.05
| Facility | | $70.79 | $81.28 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $177.83
| Professional | | $72.44 | $95.50 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $323.59
| Professional | | $79.43 | $109.65 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $144.54
| Facility | | $72.44 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $234.42
| Professional | | $87.10 | $125.89 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $512.86
| Facility | | $263.03 | $346.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $331.13
| Professional | | $64.57 | $123.03 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $102.33 / $154.88
| Facility | | $89.13 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $263.03
| Professional | | $128.82 | $181.97 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $162.18
| Facility | | $87.10 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $630.96
| Professional | | $83.18 | $134.90 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $112.20
| Professional | | $32.36 | $33.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $263.03
| Professional | | $77.62 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $302.00
| Professional | | $117.49 | $173.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $602.56
| Facility | | $239.88 | $239.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $630.96
| Professional | | $60.26 | $93.33 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $141.25
| Professional | | $138.04 | $138.04 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $245.47 / $302.00
| Professional | | $131.83 | $245.47 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $134.90
| Facility | | $79.43 | $102.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $263.03
| Professional | | $79.43 | $104.71 | $263.03 |