- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $141.25
| Facility | | $83.18 | $128.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $173.78
| Professional | | $75.86 | $112.20 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $199.53
| Professional | | $79.43 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $1,047.13
| Professional | | $93.33 | $134.90 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $239.88
| Professional | | $83.18 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $169.82 / $199.53
| Professional | | $131.83 | $169.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $281.84
| Professional | | $151.36 | $190.55 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $208.93
| Facility | | $81.28 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $1,288.25
| Facility | | $74.13 | $107.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $1,288.25
| Professional | | $107.15 | $154.88 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,344.23
| Facility | | $204.17 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $208.93
| Professional | | $69.18 | $120.23 | $208.93 |