- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $302.00 / $691.83
| Facility | | $114.82 | $302.00 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $331.13
| Professional | | $70.79 | $100.00 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $263.03
| Facility | | $204.17 | $257.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $398.11
| Professional | | $63.10 | $63.10 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $144.54
| Facility | | $95.50 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $128.82
| Professional | | $95.50 | $95.50 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $489.78
| Facility | | $263.03 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $144.54 / $302.00
| Professional | | $69.18 | $144.54 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $489.78 / $741.31
| Facility | | $104.71 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $630.96
| Professional | | $575.44 | $575.44 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $457.09
| Facility | | $95.50 | $190.55 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $323.59
| Professional | | $50.12 | $72.44 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $64.57 / $165.96
| Professional | | $33.11 | $64.57 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $245.47
| Facility | | $114.82 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $269.15
| Professional | | $95.50 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $338.84
| Professional | | $165.96 | $239.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $457.09 / $457.09
| Facility | | $190.55 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $478.63 / $489.78
| Professional | | $74.13 | $478.63 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $204.17
| Professional | | $144.54 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $524.81
| Professional | | $144.54 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $208.93
| Facility | | $34.67 | $75.86 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $72.44 / $169.82
| Professional | | $39.81 | $72.44 | $169.82 |