- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $223.87 / $281.84
| Facility | | $147.91 | $223.87 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $331.13
| Professional | | $87.10 | $128.82 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $208.93 / $295.12
| Professional | | $165.96 | $208.93 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $263.03
| Professional | | $213.80 | $251.19 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $302.00
| Facility | | $138.04 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $331.13
| Professional | | $169.82 | $239.88 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $162.18 / $208.93
| Facility | | $40.74 | $162.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $234.42
| Professional | | $45.71 | $58.88 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $234.42 / $446.68
| Facility | | $138.04 | $234.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $295.12
| Professional | | $165.96 | $239.88 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,258.93 / $1,659.59
| Facility | | $1,047.13 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $288.40
| Professional | | $204.17 | $239.88 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,513.56 / $1,949.84
| Facility | | $1,202.26 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $309.03
| Professional | | $93.33 | $114.82 | $309.03 |