- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $371.54 / $1,230.27
| Facility | | $173.78 | $371.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $316.23
| Professional | | $134.90 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $245.47 / $288.40
| Facility | | $218.78 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $245.47 / $245.47
| Professional | | $10.96 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $1,000.00
| Facility | | $134.90 | $194.98 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $426.58
| Professional | | $117.49 | $190.55 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $147.91 / $147.91
| Professional | | $38.02 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $309.03
| Professional | | $44.67 | $54.95 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $223.87 / $245.47
| Facility | | $104.71 | $223.87 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $104.71 / $323.59
| Professional | | $87.10 | $104.71 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $245.47 / $245.47
| Professional | | $40.74 | $245.47 | $245.47 |