- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $1,230.27
| Facility | | $169.82 | $251.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $380.19
| Professional | | $154.88 | $190.55 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,318.26 / $1,348.96
| Facility | | $1,148.15 | $1,318.26 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $295.12
| Professional | | $151.36 | $194.98 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $144.54 / $165.96
| Facility | | $23.99 | $144.54 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $758.58 / $1,445.44
| Facility | | $467.74 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $478.63
| Professional | | $165.96 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $501.19
| Facility | | $154.88 | $154.88 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $467.74
| Professional | | $169.82 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $229.09 / $380.19
| Professional | | $181.97 | $229.09 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $426.58 / $1,288.25
| Facility | | $407.38 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $338.84
| Professional | | $134.90 | $204.17 | $338.84 |