- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $691.83 / $1,412.54
| Facility | | $245.47 | $691.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $630.96
| Professional | | $93.33 | $125.89 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $295.12 / $630.96
| Facility | | $72.44 | $295.12 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $107.15 / $309.03
| Professional | | $61.66 | $107.15 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $741.31 / $1,995.26
| Facility | | $85.11 | $741.31 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $363.08
| Professional | | $100.00 | $144.54 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $218.78 / $457.09
| Facility | | $95.50 | $218.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $263.03
| Professional | | $69.18 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $151.36
| Professional | | $125.89 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $125.89 / $281.84
| Professional | | $100.00 | $125.89 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $125.89
| Professional | | $63.10 | $63.10 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $151.36 / $354.81
| Facility | | $91.20 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $263.03
| Professional | | $69.18 | $102.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $213.80
| Professional | | $100.00 | $128.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $125.89
| Facility | | $56.23 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $257.04
| Professional | | $52.48 | $75.86 | $257.04 |