- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $338.84
| Facility | | $186.21 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $363.08
| Professional | | $104.71 | $151.36 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $1,659.59 / $2,137.96
| Facility | | $83.18 | $1,659.59 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $512.86
| Professional | | $177.83 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $281.84 / $346.74
| Professional | | $251.19 | $281.84 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $251.19 / $724.44
| Facility | | $128.82 | $251.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $288.40 / $489.78
| Professional | | $213.80 | $288.40 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $323.59
| Facility | | $95.50 | $151.36 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $371.54
| Professional | | $74.13 | $117.49 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $263.03 / $741.31
| Facility | | $128.82 | $263.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $426.58
| Professional | | $229.09 | $302.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,995.26 / $2,630.27
| Facility | | $1,659.59 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $380.19
| Professional | | $239.88 | $295.12 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,344.23 / $3,090.30
| Facility | | $1,905.46 | $2,344.23 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $446.68
| Professional | | $144.54 | $251.19 | $446.68 |