- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $316.23 / $977.24
| Facility | | $158.49 | $316.23 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $204.17 / $323.59
| Professional | | $138.04 | $204.17 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $630.96
| Facility | | $354.81 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $338.84
| Professional | | $204.17 | $239.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $478.63 / $562.34
| Professional | | $446.68 | $478.63 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $218.78 / $316.23
| Facility | | $213.80 | $218.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $316.23
| Professional | | $208.93 | $251.19 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $239.88
| Facility | | $218.78 | $218.78 | $239.88 |
- 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
- $213.80 / $302.00 / $645.65
| Facility | | $213.80 | $302.00 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $302.00
| Professional | | $204.17 | $239.88 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $891.25
| Facility | | $323.59 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $263.03
| Professional | | $162.18 | $199.53 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $263.03 / $346.74
| Facility | | $97.72 | $263.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $263.03
| Professional | | $91.20 | $91.20 | $263.03 |