- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $199.53 / $288.40
| Facility | | $186.21 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $218.78
| Professional | | $109.65 | $162.18 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $288.40
| Facility | | $162.18 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $398.11 / $501.19
| Professional | | $162.18 | $398.11 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $346.74
| Professional | | $245.47 | $275.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $1,318.26
| Facility | | $177.83 | $346.74 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $501.19
| Professional | | $128.82 | $190.55 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $295.12 / $389.05
| Professional | | $281.84 | $295.12 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $436.52
| Professional | | $295.12 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $263.03 / $691.83
| Facility | | $107.15 | $263.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $144.54 / $288.40
| Professional | | $128.82 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $251.19
| Professional | | $199.53 | $251.19 | $251.19 |