- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $389.05 / $630.96
| Facility | | $141.25 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $141.25 / $295.12
| Professional | | $112.20 | $141.25 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $707.95
| Facility | | $134.90 | $208.93 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $363.08
| Professional | | $74.13 | $147.91 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $524.81
| Facility | | $288.40 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $190.55
| Professional | | $138.04 | $138.04 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $234.42 / $575.44
| Facility | | $114.82 | $234.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $389.05
| Professional | | $89.13 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $1,258.93 / $7,079.46
| Facility | | $114.82 | $1,258.93 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $251.19
| Professional | | $213.80 | $213.80 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $407.38
| Professional | | $147.91 | $147.91 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $707.95
| Facility | | $134.90 | $208.93 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $363.08
| Professional | | $74.13 | $147.91 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $218.78
| Facility | | $74.13 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $123.03 / $380.19
| Professional | | $58.88 | $123.03 | $380.19 |