- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $190.55 / $398.11
| Facility | | $75.86 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $158.49
| Professional | | $67.61 | $85.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $426.58
| Facility | | $100.00 | $100.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $70.79
| Professional | | $40.74 | $40.74 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $616.60 / $1,288.25
| Professional | | $91.20 | $616.60 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $251.19 / $457.09
| Facility | | $102.33 | $251.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $165.96
| Professional | | $50.12 | $63.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $141.25
| Professional | | $100.00 | $112.20 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $446.68
| Facility | | $81.28 | $134.90 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $213.80 / $446.68
| Professional | | $66.07 | $213.80 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $10,000.00
| Facility | | $91.20 | $144.54 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $10,000.00
| Professional | | $91.20 | $144.54 | $10,000.00 |
- 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
- $42.66 / $50.12 / $112.20
| Professional | | $42.66 | $50.12 | $112.20 |