- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $363.08 / $812.83
| Facility | | $123.03 | $363.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $128.82 / $158.49
| Professional | | $123.03 | $128.82 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $707.95
| Facility | | $165.96 | $165.96 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $112.20
| Professional | | $66.07 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $630.96 / $954.99
| Professional | | $398.11 | $630.96 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $338.84 / $758.58
| Facility | | $169.82 | $338.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $239.88
| Professional | | $81.28 | $100.00 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $199.53 / $245.47
| Professional | | $165.96 | $199.53 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $263.03
| Professional | | $112.20 | $229.09 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $120.23 / $141.25
| Facility | | $112.20 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $218.78 / $346.74
| Professional | | $112.20 | $218.78 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $218.78 / $10,000.00
| Facility | | $120.23 | $218.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $218.78 / $10,000.00
| Professional | | $120.23 | $218.78 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $165.96 / $234.42
| Facility | | $69.18 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $165.96
| Professional | | $69.18 | $83.18 | $165.96 |