- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $288.40 / $407.38
| Facility | | $120.23 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $295.12
| Professional | | $144.54 | $177.83 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $724.44
| Facility | | $363.08 | $363.08 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $616.60
| Professional | | $208.93 | $208.93 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $295.12 / $295.12
| Facility | | $275.42 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $53,703.18
| Facility | | $229.09 | $229.09 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $457.09
| Professional | | $165.96 | $165.96 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $1,412.54
| Facility | | $363.08 | $602.56 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $691.83
| Professional | | $223.87 | $363.08 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $123.03
| Facility | | $117.49 | $117.49 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $229.09
| Professional | | $117.49 | $213.80 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $50,118.72 / $75,857.76
| Facility | | $251.19 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $346.74
| Professional | | $239.88 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $1,023.29
| Facility | | $147.91 | $208.93 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $602.56
| Professional | | $134.90 | $239.88 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $213.80
| Facility | | $117.49 | $204.17 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $229.09
| Professional | | $117.49 | $213.80 | $229.09 |