- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $223.87 / $371.54
| Facility | | $81.28 | $223.87 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $173.78
| Professional | | $64.57 | $81.28 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $416.87
| Facility | | $79.43 | $123.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $213.80
| Professional | | $45.71 | $87.10 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $309.03
| Facility | | $169.82 | $213.80 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $112.20
| Professional | | $81.28 | $81.28 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $134.90 / $331.13
| Facility | | $67.61 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $223.87
| Professional | | $52.48 | $100.00 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $602.56 / $7,079.46
| Facility | | $56.23 | $602.56 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $147.91
| Professional | | $125.89 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $239.88
| Professional | | $87.10 | $87.10 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $416.87
| Facility | | $79.43 | $123.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $213.80
| Professional | | $45.71 | $87.10 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $87.10 / $125.89
| Facility | | $43.65 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $234.42
| Professional | | $45.71 | $72.44 | $234.42 |