- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $169.82
| Facility | | $53.70 | $64.57 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $100.00
| Professional | | $48.98 | $60.26 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $144.54
| Facility | | $134.90 | $134.90 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $131.83
| Professional | | $63.10 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $93.33
| Professional | | $70.79 | $70.79 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $87.10
| Facility | | $57.54 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $87.10
| Professional | | $63.10 | $63.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $190.55
| Professional | | $102.33 | $134.90 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $131.83
| Professional | | $57.54 | $89.13 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $87.10 / $151.36
| Facility | | $46.77 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $169.82
| Professional | | $60.26 | $72.44 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $389.05
| Facility | | $75.86 | $109.65 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $389.05
| Professional | | $75.86 | $109.65 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $134.90
| Facility | | $34.67 | $53.70 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $107.15
| Professional | | $53.70 | $66.07 | $107.15 |