- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $213.80 / $549.54
| Facility | | $177.83 | $213.80 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $213.80 / $346.74
| Professional | | $177.83 | $213.80 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $467.74
| Facility | | $446.68 | $446.68 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $501.19
| Professional | | $239.88 | $239.88 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $302.00
| Professional | | $234.42 | $234.42 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $251.19
| Facility | | $169.82 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $251.19
| Professional | | $186.21 | $186.21 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $616.60
| Professional | | $331.13 | $446.68 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $436.52
| Professional | | $199.53 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $549.54
| Facility | | $173.78 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $239.88 / $549.54
| Professional | | $213.80 | $239.88 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $1,288.25
| Facility | | $251.19 | $363.08 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $1,288.25
| Professional | | $251.19 | $363.08 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $446.68
| Facility | | $134.90 | $208.93 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $218.78 / $354.81
| Professional | | $194.98 | $218.78 | $354.81 |