- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $257.04 / $309.03
| Facility | | $165.96 | $257.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $323.59
| Professional | | $91.20 | $138.04 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Facility | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $245.47 / $346.74
| Professional | | $177.83 | $245.47 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $275.42 / $316.23
| Professional | | $229.09 | $275.42 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $363.08
| Facility | | $162.18 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $389.05
| Professional | | $194.98 | $269.15 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $154.88 / $239.88
| Facility | | $75.86 | $154.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $107.15 / $199.53
| Professional | | $56.23 | $107.15 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $436.52
| Facility | | $162.18 | $263.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $275.42 / $346.74
| Professional | | $194.98 | $275.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $812.83 / $1,071.52
| Facility | | $660.69 | $812.83 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $331.13
| Professional | | $218.78 | $269.15 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $1,148.15
| Facility | | $707.95 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $363.08
| Professional | | $107.15 | $138.04 | $363.08 |