- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $562.34
| Facility | | $154.88 | $190.55 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $346.74
| Professional | | $77.62 | $117.49 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $218.78 / $363.08
| Facility | | $204.17 | $218.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $138.04 / $194.98
| Professional | | $40.74 | $138.04 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $269.15 / $331.13
| Professional | | $138.04 | $269.15 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $125.89 / $181.97
| Facility | | $120.23 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $181.97
| Professional | | $97.72 | $125.89 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $251.19
| Facility | | $125.89 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $147.91
| Professional | | $125.89 | $125.89 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $363.08
| Facility | | $117.49 | $173.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $138.04 / $177.83
| Professional | | $79.43 | $138.04 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $371.54 / $489.78
| Facility | | $186.21 | $371.54 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $107.15 / $147.91
| Professional | | $97.72 | $107.15 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $199.53
| Facility | | $147.91 | $186.21 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $141.25
| Professional | | $34.67 | $52.48 | $141.25 |