- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $151.36
| Facility | | $52.48 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $151.36
| Professional | | $72.44 | $85.11 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $218.78
| Facility | | $85.11 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $173.78 / $204.17
| Professional | | $100.00 | $173.78 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $141.25
| Facility | | $75.86 | $114.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $199.53
| Professional | | $85.11 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $95.50
| Professional | | $79.43 | $79.43 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $275.42
| Facility | | $79.43 | $123.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $117.49
| Professional | | $30.20 | $30.20 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $194.98
| Facility | | $54.95 | $85.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $107.15
| Professional | | $58.88 | $83.18 | $107.15 |