- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $489.78 / $870.96
| Facility | | $173.78 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $181.97 / $281.84
| Professional | | $81.28 | $181.97 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $1,000.00
| Facility | | $234.42 | $234.42 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $162.18
| Professional | | $93.33 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $346.74
| Professional | | $165.96 | $218.78 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $1,071.52
| Facility | | $229.09 | $457.09 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $141.25 / $389.05
| Professional | | $114.82 | $141.25 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $331.13
| Professional | | $234.42 | $257.04 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $208.93 / $398.11
| Facility | | $186.21 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $208.93 / $489.78
| Professional | | $109.65 | $208.93 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $10,000.00
| Facility | | $208.93 | $331.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $10,000.00
| Professional | | $208.93 | $331.13 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $234.42 / $281.84
| Facility | | $141.25 | $234.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $257.04
| Professional | | $97.72 | $117.49 | $257.04 |