- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $239.88 / $338.84
| Facility | | $109.65 | $239.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $239.88
| Professional | | $114.82 | $151.36 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $602.56
| Facility | | $302.00 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $501.19
| Professional | | $165.96 | $165.96 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $245.47 / $245.47
| Facility | | $229.09 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $53,703.18
| Facility | | $169.82 | $169.82 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $354.81
| Professional | | $144.54 | $144.54 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $1,174.90
| Facility | | $302.00 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $575.44
| Professional | | $190.55 | $302.00 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $208.93
| Facility | | $199.53 | $199.53 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $190.55 / $199.53
| Professional | | $177.83 | $190.55 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $50,118.72 / $75,857.76
| Facility | | $436.52 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $288.40
| Professional | | $199.53 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $204.17 / $831.76
| Facility | | $177.83 | $204.17 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $199.53 / $501.19
| Professional | | $112.20 | $199.53 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $199.53 / $208.93
| Facility | | $177.83 | $199.53 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $190.55 / $199.53
| Professional | | $177.83 | $190.55 | $199.53 |