- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $181.97
| Facility | | $57.54 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $128.82
| Professional | | $57.54 | $70.79 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $154.88
| Facility | | $147.91 | $147.91 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $93.33
| Professional | | $44.67 | $44.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $100.00
| Professional | | $77.62 | $77.62 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $83.18
| Facility | | $64.57 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $204.17
| Professional | | $109.65 | $147.91 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $165.96
| Facility | | $66.07 | $91.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $181.97
| Professional | | $79.43 | $95.50 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $1,288.25
| Facility | | $81.28 | $131.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $1,288.25
| Professional | | $81.28 | $131.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $177.83
| Facility | | $46.77 | $67.61 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $72.44 / $120.23
| Professional | | $67.61 | $72.44 | $120.23 |