- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $537.03 / $1,096.48
| Facility | | $181.97 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $295.12
| Professional | | $162.18 | $190.55 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $1,047.13
| Facility | | $245.47 | $245.47 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $169.82
| Professional | | $97.72 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $229.09
| Professional | | $100.00 | $190.55 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $616.60 / $1,122.02
| Facility | | $251.19 | $616.60 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $407.38
| Professional | | $120.23 | $147.91 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $269.15 / $346.74
| Professional | | $245.47 | $269.15 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $239.88 / $426.58
| Facility | | $95.50 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $512.86
| Professional | | $54.95 | $95.50 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $10,000.00
| Facility | | $186.21 | $309.03 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $10,000.00
| Professional | | $186.21 | $309.03 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $295.12
| Facility | | $147.91 | $245.47 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $269.15
| Professional | | $104.71 | $123.03 | $269.15 |