- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $389.05
| Facility | | $199.53 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $223.87 / $371.54
| Professional | | $186.21 | $223.87 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $302.00 / $1,023.29
| Professional | | $162.18 | $302.00 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $288.40 / $338.84
| Professional | | $269.15 | $288.40 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $794.33 / $1,995.26
| Facility | | $338.84 | $794.33 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $645.65 / $1,659.59
| Facility | | $239.88 | $645.65 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $660.69 / $1,288.25
| Professional | | $380.19 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $70.79
| Professional | | $50.12 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $457.09 / $660.69
| Professional | | $263.03 | $457.09 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,630.27 / $2,630.27
| Facility | | $741.31 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,288.25 / $1,288.25
| Professional | | $338.84 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $616.60 / $1,230.27
| Facility | | $269.15 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $602.56 / $1,318.26
| Professional | | $380.19 | $602.56 | $1,318.26 |