- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $229.09
| Facility | | $173.78 | $223.87 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $229.09
| Professional | | $112.20 | $147.91 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $323.59
| Facility | | $107.15 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $398.11
| Professional | | $169.82 | $316.23 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $288.40
| Professional | | $229.09 | $263.03 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $1,258.93
| Facility | | $194.98 | $371.54 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $181.97 / $457.09
| Professional | | $134.90 | $181.97 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $323.59 / $371.54
| Professional | | $316.23 | $323.59 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $478.63
| Professional | | $275.42 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $288.40 / $645.65
| Facility | | $112.20 | $288.40 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $269.15
| Professional | | $131.83 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $281.84 / $281.84
| Professional | | $223.87 | $281.84 | $281.84 |