- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $165.96 / $346.74
| Facility | | $66.07 | $165.96 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $104.71
| Professional | | $48.98 | $67.61 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $371.54
| Facility | | $89.13 | $89.13 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $61.66
| Professional | | $35.48 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $218.78
| Professional | | $70.79 | $104.71 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $173.78 / $398.11
| Facility | | $75.86 | $173.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $144.54
| Professional | | $43.65 | $53.70 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $97.72 / $123.03
| Professional | | $89.13 | $97.72 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $117.49 / $151.36
| Facility | | $70.79 | $117.49 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $151.36 / $186.21
| Professional | | $54.95 | $151.36 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $10,000.00
| Facility | | $79.43 | $125.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $10,000.00
| Professional | | $79.43 | $125.89 | $10,000.00 |
- 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
- $37.15 / $43.65 / $97.72
| Professional | | $37.15 | $43.65 | $97.72 |