- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $457.09
| Facility | | $229.09 | $338.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $389.05
| Professional | | $229.09 | $229.09 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $251.19
| Facility | | $186.21 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $275.42 / $281.84
| Professional | | $269.15 | $275.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $338.84
| Professional | | $229.09 | $263.03 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $275.42 / $446.68
| Facility | | $229.09 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $251.19 / $9,549.93
| Professional | | $229.09 | $251.19 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $346.74
| Professional | | $263.03 | $338.84 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $562.34
| Professional | | $263.03 | $331.13 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $229.09 / $446.68
| Facility | | $199.53 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $229.09 / $275.42
| Professional | | $218.78 | $229.09 | $275.42 |