- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $407.38 / $1,288.25
| Facility | | $123.03 | $407.38 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $141.25 / $338.84
| Professional | | $114.82 | $141.25 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $575.44
| Facility | | $131.83 | $204.17 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $588.84
| Professional | | $104.71 | $173.78 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $346.74
| Facility | | $173.78 | $218.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $138.04 / $281.84
| Facility | | $123.03 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $208.93 / $436.52
| Professional | | $95.50 | $208.93 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $1,023.29 / $8,511.38
| Facility | | $91.20 | $1,023.29 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $295.12
| Professional | | $251.19 | $251.19 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $316.23
| Professional | | $173.78 | $173.78 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $575.44
| Facility | | $131.83 | $204.17 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $588.84
| Professional | | $104.71 | $173.78 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $208.93
| Facility | | $104.71 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $363.08
| Professional | | $104.71 | $173.78 | $363.08 |