- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $177.83
| Facility | | $144.54 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $295.12
| Professional | | $144.54 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $263.03 / $346.74
| Professional | | $22.91 | $263.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $323.59 / $346.74
| Professional | | $257.04 | $323.59 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $660.69
| Facility | | $229.09 | $229.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $229.09
| Professional | | $165.96 | $165.96 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $263.03
| Facility | | $128.82 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $208.93 / $346.74
| Professional | | $77.62 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $162.18
| Professional | | $85.11 | $128.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $467.74
| Facility | | $131.83 | $177.83 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $169.82 / $245.47
| Professional | | $141.25 | $169.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $346.74
| Professional | | $128.82 | $128.82 | $346.74 |