- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $275.42 / $426.58
| Facility | | $147.91 | $275.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $371.54
| Professional | | $131.83 | $186.21 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $501.19
| Facility | | $302.00 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $281.84 / $338.84
| Professional | | $275.42 | $281.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $691.83 / $1,479.11
| Facility | | $173.78 | $691.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $426.58 / $575.44
| Professional | | $128.82 | $426.58 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $371.54
| Facility | | $147.91 | $245.47 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $446.68
| Professional | | $269.15 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $295.12 / $1,380.38
| Facility | | $151.36 | $295.12 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $331.13
| Professional | | $131.83 | $154.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $85.11
| Professional | | $50.12 | $70.79 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $588.84
| Professional | | $213.80 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $831.76
| Professional | | $302.00 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $602.56 / $1,380.38
| Facility | | $173.78 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $1,479.11
| Professional | | $128.82 | $257.04 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $302.00
| Facility | | $89.13 | $154.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $251.19
| Professional | | $104.71 | $147.91 | $251.19 |