- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $354.81 / $501.19
| Facility | | $162.18 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $239.88 / $371.54
| Professional | | $173.78 | $239.88 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $912.01
| Facility | | $446.68 | $446.68 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $257.04 / $660.69
| Professional | | $251.19 | $257.04 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $371.54 / $371.54
| Facility | | $338.84 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- 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 / $489.78
| Professional | | $199.53 | $199.53 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $741.31 / $1,737.80
| Facility | | $446.68 | $741.31 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $851.14
| Professional | | $281.84 | $446.68 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $223.87
| Facility | | $213.80 | $213.80 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $281.84
| Professional | | $213.80 | $263.03 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $50,118.72 / $75,857.76
| Facility | | $457.09 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $436.52
| Professional | | $295.12 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $1,258.93
| Facility | | $173.78 | $309.03 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $741.31
| Professional | | $173.78 | $295.12 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $263.03
| Facility | | $213.80 | $257.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $281.84
| Professional | | $213.80 | $263.03 | $281.84 |