- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $891.25
| Facility | | $295.12 | $562.34 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $251.19 / $537.03
| Professional | | $162.18 | $251.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $776.25
| Facility | | $295.12 | $295.12 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $575.44
| Professional | | $117.49 | $117.49 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $295.12
| Facility | | $177.83 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $295.12 / $295.12
| Professional | | $213.80 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $630.96 / $1,071.52
| Facility | | $288.40 | $630.96 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $363.08 / $1,412.54
| Professional | | $177.83 | $363.08 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $1,148.15
| Facility | | $295.12 | $489.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $562.34
| Professional | | $208.93 | $251.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $524.81
| Professional | | $239.88 | $295.12 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $50,118.72
| Facility | | $380.19 | $562.34 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $302.00
| Professional | | $295.12 | $295.12 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $295.12 / $371.54
| Facility | | $269.15 | $295.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $446.68
| Professional | | $123.03 | $208.93 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $380.19
| Facility | | $251.19 | $316.23 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $295.12 / $707.95
| Professional | | $251.19 | $295.12 | $707.95 |