- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $162.18 / $380.19
| Facility | | $158.49 | $162.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $309.03
| Professional | | $128.82 | $162.18 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $912.01
| Facility | | $616.60 | $724.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $371.54
| Professional | | $162.18 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $194.98 / $1,778.28
| Professional | | $117.49 | $194.98 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $489.78 / $1,071.52
| Facility | | $275.42 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $263.03 / $660.69
| Professional | | $138.04 | $263.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $257.04
| Professional | | $169.82 | $208.93 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $851.14 / $870.96
| Professional | | $380.19 | $851.14 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $758.58
| Facility | | $158.49 | $269.15 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $676.08
| Professional | | $269.15 | $269.15 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $173.78 / $537.03
| Facility | | $74.13 | $173.78 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $229.09 / $645.65
| Professional | | $77.62 | $229.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $741.31 / $6,606.93
| Facility | | $77.62 | $741.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $257.04 / $660.69
| Professional | | $141.25 | $257.04 | $660.69 |