- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $154.88 / $223.87
| Facility | | $40.74 | $154.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $54.95 / $131.83
| Professional | | $40.74 | $54.95 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $218.78
| Facility | | $50.12 | $77.62 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $69.18 / $229.09
| Professional | | $35.48 | $69.18 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $194.98
| Facility | | $109.65 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Professional | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $134.90
| Facility | | $44.67 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $177.83
| Professional | | $37.15 | $72.44 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $117.49
| Professional | | $100.00 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $125.89
| Professional | | $69.18 | $69.18 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $218.78
| Facility | | $50.12 | $77.62 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $69.18 / $229.09
| Professional | | $35.48 | $69.18 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $70.79
| Facility | | $35.48 | $61.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $69.18 / $141.25
| Professional | | $35.48 | $69.18 | $141.25 |