- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $125.89
| Facility | | $39.81 | $47.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $50.12 / $85.11
| Professional | | $39.81 | $50.12 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $107.15
| Facility | | $100.00 | $100.00 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $123.03
| Professional | | $58.88 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $69.18
| Professional | | $52.48 | $52.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $72.44
| Facility | | $46.77 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $66.07
| Professional | | $52.48 | $52.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $141.25
| Professional | | $74.13 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $97.72
| Professional | | $48.98 | $66.07 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $66.07 / $125.89
| Facility | | $39.81 | $66.07 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $60.26 / $125.89
| Professional | | $53.70 | $60.26 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $288.40
| Facility | | $56.23 | $81.28 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $288.40
| Professional | | $56.23 | $81.28 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $100.00
| Facility | | $33.11 | $51.29 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $48.98 / $81.28
| Professional | | $45.71 | $48.98 | $81.28 |