- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $489.78
| Facility | | $158.49 | $346.74 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $331.13
| Professional | | $154.88 | $194.98 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $870.96
| Facility | | $436.52 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $691.83
| Professional | | $229.09 | $229.09 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $354.81 / $354.81
| Facility | | $331.13 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $53,703.18
| Facility | | $275.42 | $275.42 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $467.74
| Professional | | $199.53 | $199.53 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $724.44 / $1,659.59
| Facility | | $436.52 | $724.44 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $831.76
| Professional | | $275.42 | $436.52 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $371.54
| Facility | | $354.81 | $354.81 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $275.42 / $354.81
| Professional | | $257.04 | $275.42 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $50,118.72 / $75,857.76
| Facility | | $758.58 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $416.87
| Professional | | $288.40 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $1,122.02
| Facility | | $151.36 | $275.42 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $724.44
| Professional | | $151.36 | $281.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $269.15 / $371.54
| Facility | | $257.04 | $269.15 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $275.42 / $354.81
| Professional | | $257.04 | $275.42 | $354.81 |