- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $380.19
| Facility | | $144.54 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $169.82 / $239.88
| Professional | | $134.90 | $169.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $691.83
| Facility | | $338.84 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $190.55 / $501.19
| Professional | | $181.97 | $190.55 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $281.84 / $281.84
| Facility | | $257.04 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $53,703.18
| Facility | | $190.55 | $190.55 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $398.11
| Professional | | $141.25 | $141.25 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $1,318.26
| Facility | | $338.84 | $562.34 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $645.65
| Professional | | $213.80 | $338.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $275.42
| Facility | | $263.03 | $263.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $263.03
| Professional | | $213.80 | $223.87 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $50,118.72 / $75,857.76
| Facility | | $562.34 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $331.13
| Professional | | $223.87 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $933.25
| Facility | | $125.89 | $177.83 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $562.34
| Professional | | $128.82 | $223.87 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $309.03
| Facility | | $223.87 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $263.03
| Professional | | $213.80 | $223.87 | $263.03 |