- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $389.05
| Facility | | $123.03 | $151.36 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $295.12
| Professional | | $123.03 | $169.82 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $331.13
| Facility | | $309.03 | $309.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $389.05
| Professional | | $186.21 | $186.21 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $213.80
| Professional | | $162.18 | $162.18 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $190.55 / $190.55
| Facility | | $144.54 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $190.55
| Professional | | $138.04 | $138.04 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $436.52
| Professional | | $234.42 | $309.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $204.17 / $302.00
| Professional | | $194.98 | $204.17 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $380.19
| Facility | | $123.03 | $204.17 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $389.05
| Professional | | $141.25 | $165.96 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $891.25
| Facility | | $173.78 | $251.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $891.25
| Professional | | $173.78 | $251.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $309.03
| Facility | | $102.33 | $151.36 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $151.36 / $251.19
| Professional | | $141.25 | $151.36 | $251.19 |