- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $134.90 / $190.55
| Facility | | $57.54 | $134.90 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $125.89
| Professional | | $57.54 | $85.11 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $346.74
| Facility | | $173.78 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $95.50 / $251.19
| Professional | | $91.20 | $95.50 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $141.25 / $141.25
| Facility | | $131.83 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $53,703.18
| Facility | | $117.49 | $117.49 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $204.17
| Professional | | $85.11 | $85.11 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $660.69
| Facility | | $173.78 | $281.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $173.78 / $323.59
| Professional | | $107.15 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $128.82
| Facility | | $123.03 | $123.03 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $107.15 / $123.03
| Professional | | $102.33 | $107.15 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $50,118.72 / $75,857.76
| Facility | | $263.03 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $165.96
| Professional | | $112.20 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $467.74
| Facility | | $57.54 | $89.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $281.84
| Professional | | $64.57 | $112.20 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $102.33 / $128.82
| Facility | | $95.50 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $107.15 / $123.03
| Professional | | $102.33 | $107.15 | $123.03 |