- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $234.42
| Facility | | $37.15 | $48.98 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $107.15
| Professional | | $37.15 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $97.72
| Professional | | $41.69 | $60.26 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $562.34
| Professional | | $40.74 | $50.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $112.20 / $269.15
| Facility | | $104.71 | $112.20 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $117.49
| Professional | | $45.71 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $102.33
| Professional | | $41.69 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $91.20
| Professional | | $60.26 | $77.62 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $89.13
| Facility | | $39.81 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $1,174.90
| Facility | | $39.81 | $54.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $1,174.90
| Professional | | $50.12 | $66.07 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,000.00 / $2,344.23
| Facility | | $194.98 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $100.00
| Professional | | $39.81 | $58.88 | $100.00 |