- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $194.98 / $275.42
| Facility | | $89.13 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $194.98
| Professional | | $89.13 | $125.89 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $489.78
| Facility | | $245.47 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $131.83 / $354.81
| Professional | | $125.89 | $131.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $204.17
| Facility | | $186.21 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $53,703.18
| Facility | | $165.96 | $165.96 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $288.40
| Professional | | $120.23 | $120.23 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $407.38 / $954.99
| Facility | | $245.47 | $407.38 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $467.74
| Professional | | $154.88 | $245.47 | $467.74 |
- 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 / $144.54 / $154.88
| Professional | | $117.49 | $144.54 | $154.88 |
- 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
- $162.18 / $234.42 / $234.42
| Professional | | $162.18 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $645.65
| Facility | | $89.13 | $158.49 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $407.38
| Professional | | $87.10 | $162.18 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $144.54
| Facility | | $117.49 | $138.04 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $144.54 / $154.88
| Professional | | $117.49 | $144.54 | $154.88 |