- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $331.13 / $436.52
| Facility | | $131.83 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $208.93
| Professional | | $114.82 | $134.90 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $741.31
| Facility | | $173.78 | $173.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $117.49
| Professional | | $70.79 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $147.91 / $165.96
| Professional | | $134.90 | $147.91 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $891.25
| Facility | | $177.83 | $338.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $281.84
| Professional | | $87.10 | $109.65 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $194.98 / $245.47
| Professional | | $173.78 | $194.98 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $295.12
| Facility | | $131.83 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $371.54
| Professional | | $114.82 | $114.82 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $204.17 / $10,000.00
| Facility | | $147.91 | $204.17 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $204.17 / $10,000.00
| Professional | | $147.91 | $204.17 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $208.93
| Facility | | $104.71 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $87.10 / $194.98
| Professional | | $74.13 | $87.10 | $194.98 |