- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $281.84 / $478.63
| Facility | | $67.61 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $234.42
| Professional | | $64.57 | $128.82 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $776.25
| Facility | | $120.23 | $186.21 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $141.25 / $398.11
| Professional | | $60.26 | $141.25 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $323.59 / $467.74
| Facility | | $257.04 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $151.36 / $158.49
| Professional | | $91.20 | $151.36 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $275.42
| Facility | | $79.43 | $144.54 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $173.78 / $426.58
| Professional | | $53.70 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $588.84 / $7,079.46
| Facility | | $56.23 | $588.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $275.42
| Professional | | $234.42 | $234.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $346.74
| Professional | | $162.18 | $162.18 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $776.25
| Facility | | $120.23 | $186.21 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $141.25 / $398.11
| Professional | | $60.26 | $141.25 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $162.18
| Facility | | $48.98 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $100.00 / $323.59
| Professional | | $35.48 | $100.00 | $323.59 |