- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $549.54
| Facility | | $177.83 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $436.52
| Professional | | $131.83 | $165.96 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $457.09
| Facility | | $177.83 | $177.83 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $380.19
| Professional | | $87.10 | $87.10 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $177.83
| Facility | | $107.15 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $177.83
| Professional | | $128.82 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $380.19 / $630.96
| Facility | | $173.78 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $245.47 / $851.14
| Professional | | $117.49 | $245.47 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $177.83 / $489.78
| Facility | | $83.18 | $177.83 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $338.84
| Professional | | $123.03 | $158.49 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $316.23
| Professional | | $151.36 | $177.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $331.13 / $50,118.72
| Facility | | $213.80 | $331.13 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $229.09
| Professional | | $177.83 | $177.83 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $213.80 / $288.40
| Facility | | $177.83 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $371.54
| Professional | | $74.13 | $147.91 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $186.21 / $338.84
| Facility | | $109.65 | $186.21 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $562.34
| Professional | | $151.36 | $177.83 | $562.34 |