- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $162.18 / $891.25
| Facility | | $21.38 | $162.18 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $114.82 / $245.47
| Professional | | $21.88 | $114.82 | $245.47 |
- 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
- $22.39 / $128.82 / $1,202.26
| Facility | | $22.39 | $128.82 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $128.82 / $204.17
| Professional | | $22.39 | $128.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $302.00 / $645.65
| Facility | | $32.36 | $302.00 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $147.91 / $354.81
| Professional | | $25.70 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $204.17
| Professional | | $89.13 | $158.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $36.31
| Professional | | $32.36 | $33.11 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $398.11 / $398.11
| Facility | | $173.78 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $123.03 / $269.15
| Professional | | $20.89 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $125.89 / $162.18
| Professional | | $16.22 | $125.89 | $162.18 |