- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $281.84
| Facility | | $60.26 | $67.61 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $204.17
| Professional | | $60.26 | $75.86 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $724.44 / $1,905.46
| Facility | | $257.04 | $724.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $162.18
| Professional | | $75.86 | $95.50 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Professional | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $346.74
| Facility | | $72.44 | $128.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $295.12
| Professional | | $60.26 | $79.43 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $91.20
| Professional | | $44.67 | $77.62 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $131.83
| Professional | | $77.62 | $100.00 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $186.21 / $1,023.29
| Facility | | $77.62 | $186.21 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $281.84
| Professional | | $79.43 | $95.50 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $446.68 / $1,122.02
| Facility | | $436.52 | $446.68 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $288.40
| Professional | | $81.28 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $66.07
| Professional | | $60.26 | $66.07 | $66.07 |