- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $223.87
| Facility | | $109.65 | $213.80 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $323.59
| Professional | | $74.13 | $144.54 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $269.15
| Professional | | $100.00 | $151.36 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $144.54
| Facility | | $77.62 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $251.19
| Professional | | $107.15 | $134.90 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $354.81 / $562.34
| Facility | | $269.15 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $331.13
| Professional | | $89.13 | $190.55 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $199.53
| Facility | | $64.57 | $100.00 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $302.00
| Professional | | $151.36 | $213.80 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $213.80
| Facility | | $64.57 | $100.00 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $239.88 / $724.44
| Professional | | $112.20 | $239.88 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $112.20
| Professional | | $32.36 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $177.83 / $251.19
| Professional | | $67.61 | $177.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $208.93 / $331.13
| Professional | | $117.49 | $208.93 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $524.81
| Facility | | $154.88 | $154.88 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $223.87 / $724.44
| Professional | | $83.18 | $223.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $190.55
| Professional | | $141.25 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $234.42 / $338.84
| Professional | | $144.54 | $234.42 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $208.93 / $302.00
| Professional | | $89.13 | $208.93 | $302.00 |