- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $549.54
| Facility | | $275.42 | $478.63 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $245.47 / $467.74
| Professional | | $186.21 | $245.47 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $1,000.00
| Facility | | $281.84 | $281.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $501.19
| Professional | | $112.20 | $173.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $478.63 / $851.14
| Facility | | $446.68 | $478.63 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $549.54
| Professional | | $199.53 | $281.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $537.03 / $676.08
| Facility | | $288.40 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $380.19
| Professional | | $120.23 | $144.54 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $1,348.96
| Facility | | $245.47 | $338.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $1,412.54
| Professional | | $117.49 | $169.82 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $338.84
| Facility | | $117.49 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $380.19
| Professional | | $117.49 | $169.82 | $380.19 |