- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $724.44 / $1,174.90
| Facility | | $229.09 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $223.87 / $831.76
| Professional | | $89.13 | $223.87 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $457.09 / $5,011.87
| Facility | | $338.84 | $457.09 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $954.99
| Facility | | $275.42 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $302.00 / $630.96
| Professional | | $147.91 | $302.00 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $380.19
| Professional | | $194.98 | $251.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Facility | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $707.95
| Professional | | $281.84 | $446.68 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $239.88 / $954.99
| Facility | | $144.54 | $239.88 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $223.87 / $338.84
| Professional | | $70.79 | $223.87 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $309.03 / $407.38
| Facility | | $128.82 | $309.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $309.03 / $380.19
| Professional | | $281.84 | $309.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $281.84 / $338.84
| Facility | | $169.82 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $371.54
| Professional | | $117.49 | $169.82 | $371.54 |