- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,000.00 / $2,290.87
| Facility | | $87.10 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $64.57 / $138.04
| Professional | | $26.92 | $64.57 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $63.10
| Facility | | $30.90 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $64.57
| Professional | | $63.10 | $63.10 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $138.04 / $245.47
| Professional | | $72.44 | $138.04 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $72.44 / $218.78
| Facility | | $42.66 | $72.44 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $234.42
| Professional | | $38.90 | $79.43 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $204.17
| Professional | | $63.10 | $93.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $93.33
| Professional | | $38.90 | $38.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $158.49
| Professional | | $45.71 | $69.18 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $81.28 / $181.97
| Professional | | $41.69 | $81.28 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $190.55
| Professional | | $60.26 | $74.13 | $190.55 |