- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $630.96
| Facility | | $128.82 | $245.47 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $257.04
| Professional | | $61.66 | $100.00 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $165.96 / $331.13
| Facility | | $138.04 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $229.09
| Professional | | $107.15 | $114.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $125.89
| Facility | | $107.15 | $114.82 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $316.23
| Professional | | $102.33 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $288.40
| Facility | | $83.18 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $251.19
| Professional | | $83.18 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $72.44
| Professional | | $32.36 | $33.11 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $208.93 / $223.87
| Facility | | $125.89 | $208.93 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $204.17 / $363.08
| Facility | | $147.91 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $295.12
| Professional | | $151.36 | $208.93 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $165.96 / $331.13
| Facility | | $138.04 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $114.82 / $218.78
| Professional | | $112.20 | $114.82 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $123.03 / $123.03
| Facility | | $112.20 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $245.47
| Professional | | $93.33 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $125.89 / $239.88
| Professional | | $114.82 | $125.89 | $239.88 |