- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $147.91 / $234.42
| Facility | | $21.88 | $147.91 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $58.88 / $75.86
| Professional | | $10.00 | $58.88 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $371.54
| Facility | | $57.54 | $81.28 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $69.18 / $190.55
| Professional | | $20.89 | $69.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $223.87
| Facility | | $123.03 | $154.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $72.44 / $72.44
| Professional | | $14.79 | $72.44 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $144.54
| Facility | | $50.12 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $83.18 / $204.17
| Professional | | $28.84 | $83.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $93.33 / $7,079.46
| Facility | | $13.18 | $93.33 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $131.83
| Professional | | $112.20 | $112.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $165.96
| Professional | | $77.62 | $77.62 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $371.54
| Facility | | $57.54 | $81.28 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $69.18 / $190.55
| Professional | | $20.89 | $69.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $54.95 / $77.62
| Facility | | $21.38 | $54.95 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $46.77 / $147.91
| Professional | | $9.55 | $46.77 | $147.91 |