- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $177.83
| Facility | | $50.12 | $75.86 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $120.23 / $257.04
| Professional | | $51.29 | $120.23 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $95.50 / $208.93
| Professional | | $89.13 | $95.50 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $245.47
| Professional | | $104.71 | $144.54 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $64.57
| Facility | | $33.88 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $70.79 / $93.33
| Professional | | $64.57 | $70.79 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $389.05
| Facility | | $173.78 | $269.15 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $275.42
| Professional | | $112.20 | $173.78 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $331.13
| Facility | | $109.65 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $812.83
| Professional | | $123.03 | $181.97 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $194.98
| Facility | | $95.50 | $112.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $295.12
| Professional | | $112.20 | $162.18 | $295.12 |