- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $123.03 / $426.58
| Facility | | $102.33 | $123.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $147.91
| Professional | | $74.13 | $102.33 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $338.84 / $338.84
| Facility | | $275.42 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $91.20
| Professional | | $57.54 | $70.79 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $269.15 / $588.84
| Facility | | $83.18 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $173.78
| Professional | | $44.67 | $60.26 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $173.78
| Professional | | $64.57 | $64.57 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $165.96
| Facility | | $64.57 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $151.36
| Professional | | $83.18 | $134.90 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $128.82 / $151.36
| Facility | | $53.70 | $128.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $128.82
| Professional | | $53.70 | $64.57 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |