- 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 / $158.49 / $204.17
| Professional | | $128.82 | $158.49 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $676.08 / $831.76
| Facility | | $575.44 | $676.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $323.59
| Professional | | $147.91 | $208.93 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $186.21 / $398.11
| Professional | | $33.11 | $186.21 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $676.08 / $1,047.13
| Facility | | $363.08 | $676.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $309.03
| Professional | | $120.23 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $229.09
| Professional | | $158.49 | $218.78 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $154.88 / $190.55
| Professional | | $134.90 | $154.88 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $234.42 / $323.59
| Facility | | $158.49 | $234.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $154.88 / $416.87
| Facility | | $23.99 | $154.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $177.83 / $575.44
| Professional | | $27.54 | $177.83 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $562.34 / $870.96
| Facility | | $30.20 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $371.54
| Professional | | $138.04 | $213.80 | $371.54 |