- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $416.87 / $660.69
| Facility | | $218.78 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $426.58
| Professional | | $162.18 | $199.53 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $575.44
| Facility | | $218.78 | $218.78 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $478.63
| Professional | | $109.65 | $109.65 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $218.78
| Facility | | $131.83 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $218.78
| Professional | | $162.18 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $467.74 / $794.33
| Facility | | $213.80 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $309.03 / $1,071.52
| Professional | | $147.91 | $309.03 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $602.56
| Facility | | $104.71 | $218.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $416.87
| Professional | | $154.88 | $194.98 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $398.11
| Professional | | $186.21 | $218.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $50,118.72
| Facility | | $263.03 | $416.87 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $281.84
| Professional | | $218.78 | $218.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $363.08
| Facility | | $218.78 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $501.19
| Professional | | $93.33 | $154.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $186.21 / $234.42
| Facility | | $158.49 | $186.21 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $524.81
| Professional | | $186.21 | $218.78 | $524.81 |