- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $204.17
| Facility | | $114.82 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $147.91
| Professional | | $79.43 | $109.65 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $478.63
| Facility | | $223.87 | $234.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $288.40
| Professional | | $107.15 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $199.53
| Professional | | $186.21 | $186.21 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $229.09
| Facility | | $95.50 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $263.03
| Professional | | $125.89 | $173.78 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $181.97
| Facility | | $138.04 | $138.04 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $147.91
| Professional | | $100.00 | $100.00 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $181.97
| Facility | | $138.04 | $138.04 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $138.04
| Professional | | $100.00 | $100.00 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $190.55
| Professional | | $95.50 | $131.83 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $457.09
| Professional | | $208.93 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $223.87
| Facility | | $77.62 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $147.91
| Professional | | $72.44 | $102.33 | $147.91 |