- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $501.19 / $851.14
| Facility | | $239.88 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $223.87 / $416.87
| Professional | | $75.86 | $223.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $741.31
| Facility | | $281.84 | $281.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $407.38
| Professional | | $81.28 | $114.82 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $281.84 / $281.84
| Facility | | $169.82 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $281.84
| Professional | | $208.93 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $602.56 / $1,096.48
| Facility | | $275.42 | $602.56 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $239.88 / $1,380.38
| Professional | | $77.62 | $239.88 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $281.84 / $645.65
| Facility | | $31.62 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $199.53 / $549.54
| Professional | | $114.82 | $199.53 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $302.00
| Professional | | $89.13 | $165.96 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $537.03 / $50,118.72
| Facility | | $125.89 | $537.03 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $281.84 / $389.05
| Facility | | $128.82 | $281.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $144.54 / $467.74
| Professional | | $70.79 | $144.54 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $245.47 / $331.13
| Facility | | $87.10 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $245.47 / $371.54
| Professional | | $93.33 | $245.47 | $371.54 |