- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $229.09 / $263.03
| Facility | | $131.83 | $229.09 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $120.23 / $223.87
| Professional | | $89.13 | $120.23 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $478.63
| Facility | | $138.04 | $138.04 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $245.47
| Professional | | $54.95 | $85.11 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $199.53 / $354.81
| Facility | | $190.55 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $138.04 / $234.42
| Professional | | $95.50 | $138.04 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $257.04 / $331.13
| Facility | | $141.25 | $257.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $181.97
| Professional | | $58.88 | $70.79 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $645.65
| Facility | | $120.23 | $165.96 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $691.83
| Professional | | $57.54 | $81.28 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $138.04 / $165.96
| Facility | | $57.54 | $138.04 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $186.21
| Professional | | $57.54 | $81.28 | $186.21 |