- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $380.19 / $870.96
| Facility | | $125.89 | $380.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $218.78
| Professional | | $104.71 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $173.78 / $204.17
| Facility | | $154.88 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $173.78 / $173.78
| Professional | | $10.96 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $707.95
| Facility | | $100.00 | $147.91 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $295.12
| Professional | | $83.18 | $131.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $147.91
| Professional | | $104.71 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $158.49
| Professional | | $104.71 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $158.49 / $173.78
| Facility | | $74.13 | $158.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $74.13 / $229.09
| Professional | | $61.66 | $74.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $173.78
| Professional | | $104.71 | $173.78 | $173.78 |