- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $251.19 / $426.58
| Facility | | $97.72 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $338.84
| Professional | | $91.20 | $125.89 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $323.59
| Facility | | $125.89 | $125.89 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $331.13
| Professional | | $70.79 | $70.79 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $125.89 / $125.89
| Facility | | $75.86 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $125.89
| Professional | | $91.20 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $323.59 / $1,348.96
| Facility | | $123.03 | $323.59 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $660.69
| Professional | | $93.33 | $177.83 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $407.38
| Facility | | $100.00 | $162.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $239.88
| Professional | | $87.10 | $112.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $125.89 / $218.78
| Professional | | $100.00 | $125.89 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $562.34
| Facility | | $100.00 | $165.96 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $50,118.72
| Facility | | $128.82 | $223.87 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $162.18
| Professional | | $125.89 | $125.89 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $204.17
| Facility | | $125.89 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $125.89 / $281.84
| Professional | | $56.23 | $125.89 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $107.15 / $331.13
| Facility | | $100.00 | $107.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $389.05
| Professional | | $107.15 | $128.82 | $389.05 |