- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $38.02 / $223.87
| Facility | | $8.32 | $38.02 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $57.54 / $245.47
| Professional | | $30.20 | $57.54 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $363.08
| Facility | | $69.18 | $91.20 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $67.61 / $91.20
| Professional | | $32.36 | $67.61 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $114.82 / $151.36
| Facility | | $95.50 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $87.10
| Professional | | $41.69 | $61.66 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $61.66
| Facility | | $45.71 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $81.28
| Professional | | $33.11 | $33.11 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $3,630.78 / $9,772.37
| Facility | | $60.26 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $117.49
| Professional | | $77.62 | $77.62 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $81.28 / $162.18
| Facility | | $38.90 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $46.77
| Professional | | $33.11 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $363.08
| Facility | | $69.18 | $91.20 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $67.61 / $91.20
| Professional | | $32.36 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $144.54
| Professional | | $63.10 | $83.18 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $41.69 / $89.13
| Facility | | $20.89 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $77.62
| Professional | | $33.11 | $52.48 | $77.62 |