- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $489.78 / $645.65
| Facility | | $194.98 | $489.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $309.03
| Professional | | $169.82 | $194.98 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,348.96 / $1,621.81
| Facility | | $1,047.13 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $97.72
| Professional | | $57.54 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $218.78 / $245.47
| Professional | | $199.53 | $218.78 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $645.65 / $1,348.96
| Facility | | $263.03 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $288.40 / $363.08
| Professional | | $263.03 | $288.40 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $446.68
| Facility | | $194.98 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $588.84
| Facility | | $194.98 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $588.84
| Professional | | $194.98 | $302.00 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $309.03
| Facility | | $154.88 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $288.40
| Professional | | $109.65 | $128.82 | $288.40 |