- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $354.81
| Facility | | $177.83 | $309.03 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $630.96
| Professional | | $123.03 | $162.18 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $645.65
| Facility | | $186.21 | $186.21 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $218.78 / $741.31
| Professional | | $74.13 | $218.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $275.42 / $478.63
| Facility | | $257.04 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $208.93
| Professional | | $128.82 | $186.21 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $1,621.81
| Facility | | $275.42 | $407.38 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $269.15
| Professional | | $85.11 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $870.96
| Facility | | $162.18 | $223.87 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $933.25
| Professional | | $77.62 | $112.20 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $186.21 / $223.87
| Facility | | $77.62 | $186.21 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $251.19
| Professional | | $77.62 | $112.20 | $251.19 |