- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $125.89 / $208.93
| Facility | | $28.18 | $125.89 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $64.57
| Professional | | $25.70 | $50.12 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $302.00
| Facility | | $47.86 | $72.44 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $56.23 / $154.88
| Professional | | $24.55 | $56.23 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $128.82 / $181.97
| Facility | | $102.33 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $60.26
| Professional | | $38.02 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $114.82
| Facility | | $39.81 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $69.18 / $165.96
| Professional | | $22.91 | $69.18 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $234.42 / $8,511.38
| Facility | | $42.66 | $234.42 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $109.65
| Professional | | $93.33 | $93.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $134.90
| Professional | | $64.57 | $64.57 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $302.00
| Facility | | $47.86 | $72.44 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $56.23 / $154.88
| Professional | | $24.55 | $56.23 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $43.65 / $64.57
| Facility | | $20.42 | $43.65 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $131.83
| Professional | | $24.55 | $40.74 | $131.83 |