- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $933.25
| Facility | | $154.88 | $309.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $125.89 / $194.98
| Professional | | $112.20 | $125.89 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $691.83
| Facility | | $162.18 | $162.18 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $141.25
| Professional | | $81.28 | $81.28 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $457.09
| Professional | | $131.83 | $218.78 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $407.38 / $831.76
| Facility | | $165.96 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $338.84
| Professional | | $89.13 | $109.65 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $181.97 / $229.09
| Professional | | $162.18 | $181.97 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $309.03
| Facility | | $120.23 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $120.23 / $346.74
| Professional | | $47.86 | $120.23 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $10,000.00
| Facility | | $154.88 | $223.87 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $10,000.00
| Professional | | $154.88 | $223.87 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $162.18 / $269.15
| Facility | | $134.90 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $97.72 / $223.87
| Professional | | $69.18 | $97.72 | $223.87 |