- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $338.84
| Professional | | $147.91 | $213.80 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $676.08 / $1,318.26
| Facility | | $478.63 | $676.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $263.03
| Professional | | $134.90 | $186.21 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $831.76 / $1,023.29
| Facility | | $478.63 | $831.76 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $295.12
| Professional | | $87.10 | $162.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $112.20 / $288.40
| Facility | | $61.66 | $112.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $199.53
| Professional | | $58.88 | $93.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $42.66
| Professional | | $25.70 | $32.36 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $38.02 / $81.28
| Facility | | $1.74 | $38.02 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $74.13 / $102.33
| Professional | | $1.74 | $74.13 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $134.90
| Facility | | $131.83 | $131.83 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $281.84
| Professional | | $134.90 | $194.98 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $645.65 / $1,318.26
| Facility | | $446.68 | $645.65 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $251.19
| Professional | | $134.90 | $186.21 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $812.83 / $1,412.54
| Facility | | $194.98 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $275.42 / $575.44
| Professional | | $109.65 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $87.10
| Professional | | $45.71 | $51.29 | $87.10 |