- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $426.58
| Facility | | $41.69 | $50.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $50.12 / $602.56
| Professional | | $30.20 | $50.12 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $436.52
| Professional | | $257.04 | $338.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $346.74 / $562.34
| Professional | | $251.19 | $346.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $39.81 / $79.43
| Facility | | $20.42 | $39.81 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $588.84
| Professional | | $288.40 | $407.38 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,388.44 / $3,388.44
| Professional | | $1,659.59 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $2,570.40 / $5,370.32
| Facility | | $144.54 | $2,570.40 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $389.05 / $660.69
| Professional | | $40.74 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $436.52 / $851.14
| Professional | | $109.65 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $25.70 / $54.95
| Professional | | $11.22 | $25.70 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,019.95 / $5,370.32
| Facility | | $2,089.30 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $416.87 / $575.44
| Professional | | $295.12 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $100.00
| Professional | | $47.86 | $56.23 | $100.00 |