- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $25.12 / $309.03
| Facility | | $8.32 | $25.12 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $151.36 / $575.44
| Professional | | $33.11 | $151.36 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $169.82 / $588.84
| Professional | | $37.15 | $169.82 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $263.03 / $269.15
| Professional | | $239.88 | $263.03 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $144.54 / $309.03
| Facility | | $141.25 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $316.23 / $467.74
| Professional | | $141.25 | $316.23 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $1,288.25
| Facility | | $173.78 | $302.00 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $269.15
| Professional | | $95.50 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $741.31
| Professional | | $302.00 | $302.00 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $676.08 / $741.31
| Professional | | $380.19 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,148.15 / $1,348.96
| Facility | | $87.10 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $281.84
| Facility | | $95.50 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $213.80
| Professional | | $97.72 | $134.90 | $213.80 |