- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $173.78
| Facility | | $54.95 | $66.07 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $104.71
| Professional | | $54.95 | $66.07 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $144.54
| Facility | | $138.04 | $138.04 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $144.54
| Professional | | $69.18 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $93.33
| Professional | | $72.44 | $72.44 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $74.13
| Facility | | $51.29 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $74.13
| Professional | | $53.70 | $53.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $190.55
| Professional | | $102.33 | $138.04 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $134.90
| Professional | | $66.07 | $89.13 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $162.18
| Facility | | $54.95 | $89.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $87.10 / $173.78
| Professional | | $74.13 | $87.10 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $398.11
| Facility | | $77.62 | $112.20 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $398.11
| Professional | | $77.62 | $112.20 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $138.04
| Facility | | $39.81 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $67.61 / $109.65
| Professional | | $58.88 | $67.61 | $109.65 |