- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $186.21 / $537.03
| Facility | | $48.98 | $186.21 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $77.62
| Professional | | $42.66 | $52.48 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $275.42
| Facility | | $66.07 | $66.07 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $46.77
| Professional | | $26.30 | $26.30 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $125.89 / $263.03
| Professional | | $52.48 | $125.89 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $162.18 / $295.12
| Facility | | $67.61 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $109.65
| Professional | | $32.36 | $40.74 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $72.44 / $91.20
| Professional | | $66.07 | $72.44 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $112.20
| Facility | | $52.48 | $89.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $100.00 / $138.04
| Professional | | $39.81 | $100.00 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $10,000.00
| Facility | | $50.12 | $79.43 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $10,000.00
| Professional | | $56.23 | $81.28 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $81.28
| Facility | | $40.74 | $66.07 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $77.62
| Professional | | $27.54 | $33.88 | $77.62 |