- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $239.88
| Facility | | $95.50 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $323.59
| Professional | | $97.72 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $194.98
| Professional | | $112.20 | $147.91 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $457.09
| Facility | | $120.23 | $162.18 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $154.88
| Professional | | $91.20 | $120.23 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $194.98
| Professional | | $100.00 | $144.54 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $151.36
| Facility | | $131.83 | $131.83 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $177.83
| Facility | | $173.78 | $173.78 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $269.15
| Professional | | $109.65 | $158.49 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $954.99
| Professional | | $154.88 | $194.98 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $257.04
| Facility | | $97.72 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $263.03
| Professional | | $95.50 | $134.90 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $87.10 / $107.15
| Professional | | $30.20 | $87.10 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $380.19
| Facility | | $229.09 | $371.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $204.17 / $331.13
| Professional | | $104.71 | $204.17 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $257.04
| Facility | | $97.72 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $302.00
| Professional | | $107.15 | $162.18 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $177.83
| Facility | | $93.33 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $213.80
| Professional | | $97.72 | $138.04 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $169.82
| Professional | | $114.82 | $154.88 | $169.82 |