- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $269.15
| Professional | | $21.88 | $33.88 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $128.82 / $162.18
| Professional | | $47.86 | $128.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $47.86 / $77.62
| Facility | | $6.31 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $61.66 / $66.07
| Professional | | $57.54 | $61.66 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $63.10 / $69.18
| Facility | | $6.31 | $63.10 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $7.59 / $69.18
| Professional | | $6.31 | $7.59 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $2,691,534.80
| Facility | | $33.11 | $52.48 | $2,691,534.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $87.10
| Professional | | $36.31 | $42.66 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $218.78
| Facility | | $64.57 | $93.33 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $70.79
| Professional | | $46.77 | $64.57 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $31.62 / $44.67
| Facility | | $3.16 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $60.26
| Professional | | $31.62 | $31.62 | $60.26 |