- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $229.09 / $467.74
| Facility | | $89.13 | $229.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $144.54
| Professional | | $83.18 | $102.33 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $512.86
| Facility | | $120.23 | $120.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $83.18
| Professional | | $47.86 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $41.69 / $107.15
| Professional | | $19.95 | $41.69 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $234.42 / $549.54
| Facility | | $104.71 | $234.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $199.53
| Professional | | $58.88 | $72.44 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $131.83 / $169.82
| Professional | | $120.23 | $131.83 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $204.17
| Facility | | $95.50 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $251.19
| Professional | | $77.62 | $77.62 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $10,000.00
| Facility | | $107.15 | $169.82 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $10,000.00
| Professional | | $107.15 | $169.82 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $144.54
| Facility | | $72.44 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $131.83
| Professional | | $50.12 | $60.26 | $131.83 |