- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $239.88
| Facility | | $77.62 | $93.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $169.82
| Professional | | $77.62 | $93.33 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $204.17
| Facility | | $190.55 | $190.55 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $208.93
| Professional | | $100.00 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $131.83
| Professional | | $100.00 | $100.00 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $107.15
| Facility | | $85.11 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $107.15
| Professional | | $79.43 | $79.43 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $190.55 / $269.15
| Professional | | $144.54 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $190.55
| Professional | | $97.72 | $125.89 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $123.03 / $218.78
| Facility | | $74.13 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $117.49 / $239.88
| Professional | | $102.33 | $117.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $549.54
| Facility | | $93.33 | $158.49 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $549.54
| Professional | | $93.33 | $158.49 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $234.42
| Facility | | $58.88 | $85.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $93.33 / $154.88
| Professional | | $85.11 | $93.33 | $154.88 |