- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $257.04 / $512.86
| Facility | | $81.28 | $257.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $117.49
| Professional | | $63.10 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $186.21
| Professional | | $74.13 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $85.11 / $173.78
| Professional | | $77.62 | $85.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $154.88 / $218.78
| Facility | | $33.11 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $158.49
| Professional | | $61.66 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $144.54
| Professional | | $74.13 | $93.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $120.23
| Professional | | $79.43 | $100.00 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $154.88
| Facility | | $72.44 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $263.03
| Professional | | $39.81 | $39.81 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $186.21
| Facility | | $72.44 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $186.21
| Professional | | $72.44 | $104.71 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $288.40
| Facility | | $58.88 | $91.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $151.36
| Professional | | $63.10 | $93.33 | $151.36 |