- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $323.59 / $660.69
| Facility | | $125.89 | $323.59 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $131.83 / $204.17
| Professional | | $57.54 | $131.83 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $724.44
| Facility | | $169.82 | $169.82 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $117.49
| Professional | | $67.61 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $158.49 / $281.84
| Professional | | $128.82 | $158.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $331.13 / $758.58
| Facility | | $147.91 | $331.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $275.42
| Professional | | $83.18 | $102.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $186.21 / $234.42
| Professional | | $169.82 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $288.40
| Facility | | $134.90 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $354.81
| Professional | | $79.43 | $79.43 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $10,000.00
| Facility | | $151.36 | $239.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $10,000.00
| Professional | | $151.36 | $239.88 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $204.17
| Facility | | $102.33 | $169.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $186.21
| Professional | | $70.79 | $85.11 | $186.21 |