- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $436.52 / $2,511.89
| Facility | | $147.91 | $436.52 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $245.47
| Professional | | $131.83 | $177.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $851.14
| Facility | | $199.53 | $199.53 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $173.78
| Professional | | $97.72 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $223.87 / $457.09
| Professional | | $158.49 | $223.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $489.78 / $1,023.29
| Facility | | $199.53 | $489.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $416.87
| Professional | | $107.15 | $134.90 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $218.78 / $275.42
| Professional | | $199.53 | $218.78 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $371.54
| Facility | | $165.96 | $302.00 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $316.23 / $416.87
| Professional | | $144.54 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $269.15 / $10,000.00
| Facility | | $186.21 | $269.15 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $269.15 / $10,000.00
| Professional | | $186.21 | $269.15 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $323.59
| Facility | | $162.18 | $199.53 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $269.15
| Professional | | $83.18 | $117.49 | $269.15 |