- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $204.17 / $354.81
| Facility | | $102.33 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $234.42
| Professional | | $77.62 | $107.15 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $263.03
| Facility | | $102.33 | $102.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $165.96
| Professional | | $40.74 | $40.74 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $102.33
| Facility | | $61.66 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $588.84
| Professional | | $102.33 | $102.33 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $218.78 / $912.01
| Facility | | $100.00 | $218.78 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $144.54 / $489.78
| Professional | | $61.66 | $144.54 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $281.84
| Facility | | $107.15 | $131.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $194.98
| Professional | | $70.79 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $181.97
| Professional | | $81.28 | $97.72 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $457.09
| Facility | | $338.84 | $338.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $50,118.72
| Facility | | $131.83 | $194.98 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $104.71
| Professional | | $102.33 | $102.33 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $102.33 / $128.82
| Facility | | $91.20 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $85.11 / $229.09
| Professional | | $42.66 | $85.11 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $109.65
| Facility | | $87.10 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $245.47
| Professional | | $81.28 | $97.72 | $245.47 |