- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $199.53 / $549.54
| Facility | | $70.79 | $199.53 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $194.98
| Professional | | $67.61 | $85.11 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $407.38
| Facility | | $95.50 | $95.50 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $79.43
| Professional | | $45.71 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $169.82 / $354.81
| Professional | | $85.11 | $169.82 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $234.42 / $489.78
| Facility | | $95.50 | $234.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $190.55
| Professional | | $50.12 | $61.66 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $104.71 / $131.83
| Professional | | $95.50 | $104.71 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $138.04 / $281.84
| Facility | | $79.43 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $199.53 / $281.84
| Professional | | $74.13 | $199.53 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $10,000.00
| Facility | | $87.10 | $128.82 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $10,000.00
| Professional | | $87.10 | $128.82 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $151.36
| Facility | | $75.86 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $125.89
| Professional | | $39.81 | $56.23 | $125.89 |