- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $338.84
| Facility | | $208.93 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $537.03
| Professional | | $208.93 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $660.69
| Professional | | $323.59 | $323.59 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $51.29 / $676.08
| Facility | | $47.86 | $51.29 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $676.08
| Professional | | $51.29 | $51.29 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $338.84 / $50,118.72
| Facility | | $64.57 | $338.84 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $288.40 / $1,445.44
| Professional | | $46.77 | $288.40 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $467.74
| Professional | | $446.68 | $446.68 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $177.83 / $275.42
| Facility | | $26.92 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $245.47 / $426.58
| Professional | | $125.89 | $245.47 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $446.68
| Facility | | $309.03 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $446.68 / $467.74
| Professional | | $371.54 | $446.68 | $467.74 |