- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $302.00
| Facility | | $128.82 | $245.47 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $97.72 / $162.18
| Professional | | $75.86 | $97.72 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $295.12 / $302.00
| Facility | | $234.42 | $295.12 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $446.68
| Professional | | $53.70 | $53.70 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $562.34
| Facility | | $302.00 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $338.84
| Professional | | $114.82 | $162.18 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $616.60 / $933.25
| Facility | | $120.23 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $724.44
| Professional | | $660.69 | $660.69 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $380.19
| Facility | | $97.72 | $141.25 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $89.13 / $389.05
| Professional | | $63.10 | $89.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $109.65
| Professional | | $54.95 | $64.57 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $131.83 / $169.82
| Facility | | $117.49 | $131.83 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $186.21 / $309.03
| Professional | | $109.65 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $380.19
| Professional | | $190.55 | $275.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $512.86
| Facility | | $288.40 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $549.54 / $549.54
| Professional | | $131.83 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $234.42
| Professional | | $112.20 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $602.56
| Professional | | $112.20 | $112.20 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $97.72 / $263.03
| Facility | | $38.90 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $177.83
| Professional | | $45.71 | $85.11 | $177.83 |