- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $288.40
| Facility | | $42.66 | $79.43 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $45.71 / $67.61
| Professional | | $37.15 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $35.48
| Professional | | $33.88 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $218.78 / $218.78
| Facility | | $112.20 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $45.71 / $52.48
| Professional | | $22.91 | $45.71 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $104.71 / $229.09
| Facility | | $35.48 | $104.71 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $77.62
| Professional | | $26.30 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $93.33 / $138.04
| Professional | | $15.14 | $93.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $45.71 / $100.00
| Facility | | $40.74 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $112.20 / $123.03
| Professional | | $40.74 | $112.20 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $741.31
| Facility | | $380.19 | $380.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $51.29 / $89.13
| Facility | | $25.70 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $35.48 / $70.79
| Professional | | $21.38 | $35.48 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |