- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $288.40 / $371.54
| Facility | | $112.20 | $288.40 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $173.78
| Professional | | $97.72 | $123.03 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $645.65
| Facility | | $151.36 | $151.36 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Professional | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $158.49
| Professional | | $128.82 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $295.12 / $776.25
| Facility | | $154.88 | $295.12 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $239.88
| Professional | | $74.13 | $93.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $165.96 / $208.93
| Professional | | $151.36 | $165.96 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $257.04
| Facility | | $112.20 | $151.36 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $316.23
| Professional | | $97.72 | $97.72 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $10,000.00
| Facility | | $128.82 | $177.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $10,000.00
| Professional | | $128.82 | $181.97 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $151.36 / $181.97
| Facility | | $91.20 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $165.96
| Professional | | $63.10 | $75.86 | $165.96 |