- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $229.09 / $295.12
| Facility | | $138.04 | $229.09 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $186.21
| Professional | | $75.86 | $117.49 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $316.23 / $660.69
| Facility | | $112.20 | $316.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $295.12
| Professional | | $60.26 | $100.00 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $288.40
| Facility | | $162.18 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $109.65
| Professional | | $100.00 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $141.25 / $213.80
| Facility | | $66.07 | $141.25 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $263.03
| Professional | | $60.26 | $107.15 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $173.78
| Professional | | $144.54 | $144.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $181.97
| Professional | | $100.00 | $100.00 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $316.23 / $660.69
| Facility | | $112.20 | $316.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $295.12
| Professional | | $60.26 | $100.00 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $120.23
| Facility | | $60.26 | $100.00 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $208.93
| Professional | | $60.26 | $100.00 | $208.93 |