- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $562.34 / $676.08
| Facility | | $177.83 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $162.18 / $269.15
| Professional | | $134.90 | $162.18 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $616.60 / $630.96
| Facility | | $446.68 | $616.60 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $181.97 / $323.59
| Professional | | $91.20 | $181.97 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $446.68 / $912.01
| Facility | | $154.88 | $446.68 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $97.72 / $281.84
| Professional | | $93.33 | $97.72 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $181.97 / $302.00
| Facility | | $158.49 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $213.80
| Professional | | $204.17 | $204.17 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $239.88 / $245.47
| Facility | | $120.23 | $239.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $263.03
| Professional | | $85.11 | $120.23 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,513.56
| Professional | | $1,023.29 | $1,023.29 | $1,513.56 |