- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $165.96
| Professional | | $54.95 | $69.18 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $9.55
| Facility | | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $100.00 / $371.54
| Professional | | $69.18 | $100.00 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $338.84
| Facility | | $213.80 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $446.68
| Professional | | $104.71 | $154.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $109.65
| Facility | | $81.28 | $81.28 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $141.25
| Professional | | $69.18 | $81.28 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $154.88
| Professional | | $128.82 | $128.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $112.20 / $194.98
| Professional | | $97.72 | $112.20 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $602.56 / $602.56
| Facility | | $199.53 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $186.21
| Facility | | $57.54 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $100.00
| Professional | | $69.18 | $81.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $131.83
| Professional | | $97.72 | $128.82 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $52.48 / $83.18
| Facility | | $5.75 | $52.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $151.36
| Professional | | $61.66 | $75.86 | $151.36 |