- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $524.81 / $977.24
| Facility | | $186.21 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $186.21 / $234.42
| Professional | | $162.18 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,288.25 / $1,548.82
| Facility | | $1,000.00 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $114.82
| Professional | | $66.07 | $66.07 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $208.93 / $234.42
| Professional | | $190.55 | $208.93 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $1,258.93
| Facility | | $251.19 | $489.78 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $275.42 / $346.74
| Professional | | $251.19 | $275.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $426.58
| Facility | | $186.21 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $524.81
| Professional | | $162.18 | $162.18 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $251.19 / $478.63
| Facility | | $67.61 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $251.19 / $478.63
| Professional | | $67.61 | $251.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $295.12
| Facility | | $147.91 | $251.19 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $275.42
| Professional | | $104.71 | $123.03 | $275.42 |