- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $323.59 / $467.74
| Facility | | $138.04 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $234.42 / $575.44
| Professional | | $173.78 | $234.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $831.76
| Facility | | $416.87 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $691.83
| Professional | | $234.42 | $234.42 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $338.84 / $338.84
| Facility | | $316.23 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $53,703.18
| Facility | | $223.87 | $234.42 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $436.52
| Professional | | $173.78 | $173.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $676.08 / $1,584.89
| Facility | | $416.87 | $676.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $794.33
| Professional | | $263.03 | $416.87 | $794.33 |
- 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
- $245.47 / $257.04 / $263.03
| Professional | | $245.47 | $257.04 | $263.03 |
- 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
- $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
- $269.15 / $398.11 / $398.11
| Professional | | $269.15 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $1,148.15
| Facility | | $144.54 | $218.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $691.83
| Professional | | $158.49 | $269.15 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $251.19 / $275.42
| Facility | | $245.47 | $251.19 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $257.04 / $263.03
| Professional | | $245.47 | $257.04 | $263.03 |