- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $5,128.61
| Facility | | $61.66 | $81.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $83.18
| Professional | | $61.66 | $61.66 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $63.10
| Facility | | $60.26 | $60.26 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $75.86
| Facility | | $70.79 | $70.79 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $95.50
| Facility | | $66.07 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $67.61
| Professional | | $60.26 | $60.26 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $204.17
| Facility | | $56.23 | $74.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $83.18
| Professional | | $63.10 | $64.57 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $50,118.72 / $75,857.76
| Facility | | $81.28 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $69.18 / $104.71
| Facility | | $60.26 | $69.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $69.18 / $81.28
| Professional | | $66.07 | $69.18 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $69.18
| Facility | | $61.66 | $61.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |