- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $346.74
| Facility | | $107.15 | $199.53 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $154.88
| Professional | | $57.54 | $85.11 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $501.19
| Facility | | $77.62 | $120.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $97.72 / $257.04
| Professional | | $53.70 | $97.72 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $302.00
| Facility | | $169.82 | $208.93 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $100.00 / $100.00
| Professional | | $83.18 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $251.19
| Facility | | $69.18 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $114.82 / $275.42
| Professional | | $48.98 | $114.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $323.59 / $7,079.46
| Facility | | $58.88 | $323.59 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $181.97
| Professional | | $151.36 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $229.09
| Professional | | $107.15 | $107.15 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $501.19
| Facility | | $77.62 | $120.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $97.72 / $257.04
| Professional | | $53.70 | $97.72 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $93.33 / $107.15
| Facility | | $44.67 | $93.33 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $257.04
| Professional | | $52.48 | $79.43 | $257.04 |