- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $501.19
| Facility | | $251.19 | $436.52 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $426.58
| Professional | | $169.82 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $912.01
| Facility | | $263.03 | $263.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $158.49 / $467.74
| Professional | | $23.44 | $158.49 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $380.19 / $676.08
| Facility | | $363.08 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $263.03 / $288.40
| Professional | | $181.97 | $263.03 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $616.60
| Facility | | $354.81 | $549.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $245.47 / $371.54
| Professional | | $117.49 | $245.47 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $1,230.27
| Facility | | $208.93 | $323.59 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $1,288.25
| Professional | | $109.65 | $154.88 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $263.03 / $309.03
| Facility | | $109.65 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $309.03
| Professional | | $109.65 | $154.88 | $309.03 |