- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $263.03
| Facility | | $83.18 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $125.89 / $302.00
| Professional | | $72.44 | $125.89 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $47.86 / $47.86
| Professional | | $40.74 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $338.84
| Facility | | $95.50 | $95.50 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $75.86 / $204.17
| Professional | | $41.69 | $75.86 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $194.98
| Facility | | $165.96 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $204.17
| Professional | | $67.61 | $95.50 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $478.63
| Facility | | $112.20 | $186.21 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $151.36
| Professional | | $45.71 | $75.86 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $457.09
| Facility | | $83.18 | $141.25 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $70.79 / $478.63
| Professional | | $39.81 | $70.79 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $95.50 / $114.82
| Facility | | $47.86 | $95.50 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $128.82
| Professional | | $39.81 | $57.54 | $128.82 |