- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $933.25
| Facility | | $263.03 | $323.59 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $323.59
| Professional | | $123.03 | $194.98 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $467.74 / $602.56
| Facility | | $338.84 | $467.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $229.09 / $371.54
| Professional | | $81.28 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $457.09 / $537.03
| Professional | | $426.58 | $457.09 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $208.93 / $288.40
| Facility | | $204.17 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $302.00
| Professional | | $177.83 | $218.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $416.87
| Facility | | $208.93 | $208.93 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $251.19
| Professional | | $208.93 | $208.93 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $288.40 / $602.56
| Facility | | $128.82 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $229.09 / $295.12
| Professional | | $79.43 | $229.09 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $630.96 / $870.96
| Facility | | $316.23 | $630.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $169.82 / $251.19
| Professional | | $134.90 | $169.82 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $251.19 / $331.13
| Facility | | $83.18 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $251.19
| Professional | | $75.86 | $87.10 | $251.19 |