- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $138.04
| Professional | | $75.86 | $93.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $12.30
| Facility | | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $501.19
| Professional | | $93.33 | $128.82 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $302.00
| Facility | | $29.51 | $44.67 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $234.42 / $251.19
| Professional | | $229.09 | $234.42 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $186.21
| Facility | | $109.65 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $186.21
| Professional | | $93.33 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $151.36
| Professional | | $125.89 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $194.98 / $831.76
| Professional | | $173.78 | $194.98 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $812.83 / $812.83
| Facility | | $208.93 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $109.65 / $208.93
| Facility | | $25.12 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $109.65
| Professional | | $79.43 | $93.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $128.82
| Professional | | $125.89 | $125.89 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $60.26 / $109.65
| Facility | | $7.94 | $60.26 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $181.97
| Professional | | $70.79 | $100.00 | $181.97 |