- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $199.53 / $234.42
| Facility | | $114.82 | $199.53 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $199.53
| Professional | | $79.43 | $104.71 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $416.87
| Facility | | $120.23 | $120.23 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $74.13 / $208.93
| Professional | | $3.16 | $74.13 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $177.83 / $309.03
| Facility | | $165.96 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $134.90
| Professional | | $83.18 | $120.23 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $234.42 / $288.40
| Facility | | $63.10 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $93.33 / $173.78
| Professional | | $54.95 | $93.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $812.83
| Facility | | $104.71 | $144.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $602.56
| Professional | | $50.12 | $72.44 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $120.23 / $144.54
| Facility | | $50.12 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $162.18
| Professional | | $50.12 | $72.44 | $162.18 |