- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $316.23
| Facility | | $151.36 | $208.93 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $512.86
| Professional | | $123.03 | $177.83 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $426.58
| Professional | | $144.54 | $186.21 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $229.09
| Facility | | $37.15 | $37.15 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $229.09 / $269.15
| Professional | | $37.15 | $229.09 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $549.54 / $1,258.93
| Facility | | $269.15 | $549.54 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $263.03 / $616.60
| Professional | | $125.89 | $263.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $398.11
| Facility | | $95.50 | $147.91 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $190.55 / $288.40
| Professional | | $147.91 | $190.55 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Facility | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $169.82 / $245.47
| Professional | | $23.99 | $169.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $53,703.18
| Facility | | $112.20 | $223.87 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $257.04 / $275.42
| Professional | | $218.78 | $257.04 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $851.14 / $977.24
| Facility | | $281.84 | $851.14 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $194.98 / $467.74
| Professional | | $117.49 | $194.98 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $107.15 / $281.84
| Facility | | $20.42 | $107.15 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $302.00
| Professional | | $107.15 | $169.82 | $302.00 |