- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $223.87
| Facility | | $109.65 | $131.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $239.88
| Professional | | $109.65 | $134.90 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $288.40
| Facility | | $275.42 | $275.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $309.03
| Professional | | $147.91 | $147.91 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $186.21
| Professional | | $147.91 | $147.91 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $134.90
| Facility | | $114.82 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $134.90
| Professional | | $97.72 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $380.19
| Professional | | $204.17 | $275.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $269.15
| Professional | | $138.04 | $177.83 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $316.23
| Facility | | $109.65 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $338.84
| Professional | | $125.89 | $177.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $794.33
| Facility | | $154.88 | $223.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $794.33
| Professional | | $154.88 | $223.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $331.13
| Facility | | $83.18 | $120.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $134.90 / $218.78
| Professional | | $123.03 | $134.90 | $218.78 |