- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $281.84 / $467.74
| Facility | | $138.04 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $363.08
| Professional | | $95.50 | $128.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $380.19
| Facility | | $144.54 | $144.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $338.84
| Professional | | $70.79 | $70.79 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $144.54
| Facility | | $87.10 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $144.54
| Professional | | $104.71 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $363.08 / $1,348.96
| Facility | | $141.25 | $363.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $199.53 / $758.58
| Professional | | $95.50 | $199.53 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $144.54 / $398.11
| Facility | | $50.12 | $144.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $123.03 / $275.42
| Professional | | $102.33 | $123.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $144.54 / $257.04
| Professional | | $123.03 | $144.54 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $302.00
| Facility | | $144.54 | $257.04 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $275.42 / $50,118.72
| Facility | | $154.88 | $275.42 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $177.83
| Professional | | $144.54 | $144.54 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $173.78 / $204.17
| Facility | | $144.54 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $144.54 / $316.23
| Professional | | $64.57 | $144.54 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $457.09
| Facility | | $107.15 | $158.49 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $467.74
| Professional | | $123.03 | $151.36 | $467.74 |