- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $467.74 / $776.25
| Facility | | $263.03 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $213.80 / $478.63
| Professional | | $141.25 | $213.80 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $676.08
| Facility | | $263.03 | $263.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $104.71 / $371.54
| Professional | | $45.71 | $104.71 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $263.03
| Facility | | $154.88 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $263.03
| Professional | | $190.55 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $933.25
| Facility | | $251.19 | $363.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $316.23 / $1,258.93
| Professional | | $158.49 | $316.23 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $263.03 / $588.84
| Facility | | $12.02 | $263.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $489.78
| Professional | | $128.82 | $181.97 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $467.74
| Professional | | $173.78 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $50,118.72
| Facility | | $338.84 | $489.78 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $269.15
| Professional | | $263.03 | $263.03 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $323.59
| Facility | | $169.82 | $263.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $389.05
| Professional | | $109.65 | $158.49 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $275.42
| Facility | | $223.87 | $223.87 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $616.60
| Professional | | $162.18 | $245.47 | $616.60 |