- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $269.15 / $416.87
| Facility | | $141.25 | $269.15 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $144.54 / $269.15
| Professional | | $117.49 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $186.21 / $323.59
| Facility | | $162.18 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $257.04
| Professional | | $70.79 | $89.13 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $199.53
| Facility | | $162.18 | $162.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $229.09 / $891.25
| Facility | | $169.82 | $229.09 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $338.84
| Professional | | $79.43 | $128.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $117.49 / $602.56
| Facility | | $114.82 | $117.49 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $316.23
| Professional | | $79.43 | $128.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $158.49 / $218.78
| Professional | | $131.83 | $158.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $354.81
| Professional | | $147.91 | $208.93 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $173.78 / $263.03
| Facility | | $158.49 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $208.93
| Professional | | $74.13 | $104.71 | $208.93 |