- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $407.38
| Facility | | $128.82 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $204.17
| Professional | | $75.86 | $131.83 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $169.82 / $295.12
| Facility | | $147.91 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $186.21
| Professional | | $64.57 | $81.28 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $186.21
| Facility | | $95.50 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $660.69
| Facility | | $104.71 | $194.98 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $245.47
| Professional | | $43.65 | $75.86 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $549.54
| Facility | | $79.43 | $104.71 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $104.71
| Professional | | $43.65 | $74.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $199.53
| Professional | | $120.23 | $144.54 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $331.13
| Professional | | $112.20 | $169.82 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $162.18 / $245.47
| Facility | | $58.88 | $162.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $162.18
| Professional | | $42.66 | $67.61 | $162.18 |