- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $181.97 / $912.01
| Facility | | $25.70 | $181.97 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $123.03 / $245.47
| Professional | | $21.88 | $123.03 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $177.83 / $446.68
| Professional | | $26.30 | $177.83 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $22.39 / $288.40
| Professional | | $20.42 | $22.39 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $389.05 / $1,122.02
| Facility | | $51.29 | $389.05 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $165.96 / $316.23
| Professional | | $23.44 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $346.74
| Professional | | $147.91 | $186.21 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $275.42 / $295.12
| Professional | | $218.78 | $275.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $162.18 / $323.59
| Facility | | $25.70 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $977.24
| Professional | | $45.71 | $45.71 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $60.26
| Facility | | $22.39 | $30.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $467.74
| Professional | | $186.21 | $251.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $575.44 / $2,041.74
| Facility | | $15.85 | $575.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $123.03 / $316.23
| Professional | | $22.39 | $123.03 | $316.23 |