- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $316.23
| Facility | | $100.00 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $269.15
| Professional | | $93.33 | $117.49 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $131.83 / $229.09
| Facility | | $114.82 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $162.18
| Professional | | $61.66 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $144.54
| Facility | | $83.18 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $512.86
| Facility | | $83.18 | $162.18 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $208.93
| Professional | | $60.26 | $70.79 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $478.63
| Facility | | $81.28 | $81.28 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $173.78
| Professional | | $60.26 | $67.61 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $112.20 / $154.88
| Professional | | $93.33 | $112.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $257.04
| Professional | | $87.10 | $131.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $125.89 / $186.21
| Facility | | $63.10 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $151.36
| Professional | | $52.48 | $75.86 | $151.36 |