- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $524.81 / $870.96
| Facility | | $288.40 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $245.47 / $537.03
| Professional | | $158.49 | $245.47 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $758.58
| Facility | | $288.40 | $288.40 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $537.03
| Professional | | $117.49 | $117.49 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $288.40
| Facility | | $173.78 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $288.40 / $288.40
| Professional | | $213.80 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $616.60 / $1,047.13
| Facility | | $281.84 | $616.60 | $1,047.13 |
- 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
- $54.95 / $288.40 / $794.33
| Facility | | $54.95 | $288.40 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $549.54
| Professional | | $204.17 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $275.42 / $524.81
| Professional | | $158.49 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $549.54 / $50,118.72
| Facility | | $380.19 | $549.54 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $302.00
| Professional | | $288.40 | $288.40 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $295.12 / $363.08
| Facility | | $263.03 | $295.12 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $602.56
| Professional | | $123.03 | $204.17 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $245.47 / $309.03
| Facility | | $53.70 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $691.83
| Professional | | $144.54 | $275.42 | $691.83 |