- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $288.40
| Facility | | $234.42 | $251.19 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $478.63
| Professional | | $229.09 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $416.87 / $2,570.40
| Professional | | $354.81 | $416.87 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $562.34
| Professional | | $407.38 | $524.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $912.01
| Facility | | $363.08 | $363.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $363.08
| Professional | | $263.03 | $263.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $269.15
| Facility | | $190.55 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $331.13 / $562.34
| Professional | | $239.88 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $323.59
| Professional | | $169.82 | $263.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $275.42 / $691.83
| Facility | | $194.98 | $275.42 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $363.08
| Professional | | $213.80 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $562.34
| Professional | | $263.03 | $263.03 | $562.34 |