- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $741.31 / $741.31
| Facility | | $199.53 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $724.44
| Professional | | $281.84 | $489.78 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $123.03 / $363.08
| Professional | | $66.07 | $123.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $398.11
| Facility | | $213.80 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $199.53 / $316.23
| Professional | | $77.62 | $199.53 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $478.63 / $3,801.89
| Facility | | $72.44 | $478.63 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $186.21
| Professional | | $85.11 | $158.49 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $302.00 / $851.14
| Facility | | $72.44 | $302.00 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $602.56 / $1,318.26
| Professional | | $107.15 | $602.56 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $75.86
| Professional | | $27.54 | $35.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $257.04
| Professional | | $239.88 | $239.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $173.78 / $281.84
| Professional | | $91.20 | $173.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $851.14 / $851.14
| Facility | | $158.49 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $346.74 / $851.14
| Professional | | $97.72 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $489.78 / $575.44
| Professional | | $199.53 | $489.78 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $831.76 / $1,905.46
| Facility | | $27.54 | $831.76 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $602.56 / $1,737.80
| Professional | | $120.23 | $602.56 | $1,737.80 |