- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $70.79
| Facility | | $48.98 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $85.11
| Professional | | $48.98 | $70.79 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $72.44 / $177.83
| Professional | | $57.54 | $72.44 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $69.18
| Facility | | $30.90 | $30.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $69.18 / $100.00
| Professional | | $30.90 | $69.18 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $1,071.52
| Facility | | $117.49 | $181.97 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $131.83 / $489.78
| Professional | | $57.54 | $131.83 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $323.59 / $1,071.52
| Facility | | $120.23 | $323.59 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $724.44
| Professional | | $229.09 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $257.04
| Professional | | $109.65 | $169.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $50,118.72 / $75,857.76
| Facility | | $489.78 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,096.48 / $1,318.26
| Facility | | $467.74 | $1,096.48 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $323.59 / $933.25
| Professional | | $95.50 | $323.59 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $257.04
| Facility | | $102.33 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $316.23
| Professional | | $102.33 | $190.55 | $316.23 |