- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $165.96 / $257.04
| Facility | | $48.98 | $165.96 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $169.82
| Professional | | $48.98 | $70.79 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $257.04 / $416.87
| Facility | | $97.72 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $257.04
| Professional | | $52.48 | $89.13 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $251.19
| Facility | | $141.25 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $173.78
| Facility | | $56.23 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $93.33 / $229.09
| Professional | | $47.86 | $93.33 | $229.09 |
- 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
- $128.82 / $128.82 / $151.36
| Professional | | $128.82 | $128.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $162.18
| Professional | | $89.13 | $89.13 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $257.04 / $416.87
| Facility | | $97.72 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $257.04
| Professional | | $52.48 | $89.13 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $104.71
| Facility | | $52.48 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $181.97
| Professional | | $52.48 | $89.13 | $181.97 |