- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $275.42 / $398.11
| Facility | | $125.89 | $275.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $354.81
| Professional | | $162.18 | $234.42 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $371.54 / $660.69
| Facility | | $302.00 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $436.52 / $436.52
| Professional | | $407.38 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $245.47
| Facility | | $190.55 | $234.42 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $234.42
| Professional | | $169.82 | $169.82 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $338.84 / $446.68
| Facility | | $117.49 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $354.81 / $416.87
| Professional | | $218.78 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $331.13
| Professional | | $30.20 | $30.20 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $380.19 / $380.19
| Facility | | $363.08 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $416.87
| Professional | | $275.42 | $275.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $407.38
| Professional | | $309.03 | $389.05 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $208.93 / $239.88
| Facility | | $181.97 | $208.93 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $181.97 / $288.40
| Professional | | $169.82 | $181.97 | $288.40 |