- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $537.03 / $912.01
| Facility | | $194.98 | $537.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $380.19
| Professional | | $125.89 | $165.96 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $933.25 / $5,011.87
| Facility | | $691.83 | $933.25 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $288.40 / $630.96
| Facility | | $138.04 | $288.40 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $204.17 / $316.23
| Professional | | $75.86 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $302.00
| Professional | | $97.72 | $147.91 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $194.98 / $363.08
| Professional | | $138.04 | $194.98 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $346.74 / $707.95
| Facility | | $169.82 | $346.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $169.82 / $239.88
| Professional | | $125.89 | $169.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $208.93
| Facility | | $181.97 | $181.97 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $208.93
| Professional | | $181.97 | $181.97 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $208.93 / $251.19
| Facility | | $89.13 | $208.93 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $295.12
| Professional | | $87.10 | $125.89 | $295.12 |