- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $147.91 / $630.96
| Facility | | $128.82 | $147.91 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $154.88 / $316.23
| Professional | | $120.23 | $154.88 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $812.83 / $2,137.96
| Facility | | $323.59 | $812.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $537.03
| Professional | | $223.87 | $338.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $1,318.26
| Facility | | $389.05 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $645.65
| Professional | | $251.19 | $416.87 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $1,047.13
| Facility | | $426.58 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $602.56
| Professional | | $251.19 | $380.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $251.19 / $575.44
| Facility | | $125.89 | $251.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | 54 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $295.12 / $954.99
| Professional | | $144.54 | $295.12 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,778.28 / $3,715.35
| Facility | | $616.60 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $269.15 / $501.19
| Professional | | $125.89 | $269.15 | $501.19 |