- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $323.59 / $457.09
| Facility | | $134.90 | $323.59 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $173.78 / $251.19
| Professional | | $134.90 | $173.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $812.83
| Facility | | $407.38 | $407.38 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $190.55 / $562.34
| Professional | | $181.97 | $190.55 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $331.13 / $331.13
| Facility | | $309.03 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $53,703.18
| Facility | | $186.21 | $186.21 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $398.11
| Professional | | $138.04 | $138.04 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $676.08 / $1,584.89
| Facility | | $407.38 | $676.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $776.25
| Professional | | $257.04 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $316.23
| Facility | | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $257.04 / $302.00
| Professional | | $239.88 | $257.04 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $50,118.72 / $75,857.76
| Facility | | $660.69 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $389.05
| Professional | | $269.15 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $912.01
| Facility | | $123.03 | $173.78 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $269.15 / $676.08
| Professional | | $134.90 | $269.15 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $251.19 / $316.23
| Facility | | $239.88 | $251.19 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $257.04 / $302.00
| Professional | | $239.88 | $257.04 | $302.00 |