- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $426.58 / $575.44
| Facility | | $181.97 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $151.36 / $316.23
| Professional | | $52.48 | $151.36 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $112.20
| Facility | | $54.95 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $112.20
| Professional | | $54.95 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $331.13
| Professional | | $128.82 | $162.18 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $154.88 / $354.81
| Facility | | $75.86 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $218.78 / $933.25
| Professional | | $97.72 | $218.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $134.90 / $251.19
| Professional | | $128.82 | $134.90 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $223.87
| Professional | | $123.03 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $223.87
| Professional | | $97.72 | $177.83 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $141.25 / $288.40
| Professional | | $75.86 | $141.25 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $128.82 / $251.19
| Professional | | $104.71 | $128.82 | $251.19 |