- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $457.09 / $977.24
| Facility | | $158.49 | $457.09 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $398.11
| Professional | | $100.00 | $169.82 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $794.33
| Facility | | $186.21 | $186.21 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $131.83
| Professional | | $74.13 | $74.13 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $371.54 / $776.25
| Professional | | $147.91 | $371.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $380.19 / $831.76
| Facility | | $190.55 | $380.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $114.82 / $309.03
| Professional | | $91.20 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $257.04
| Professional | | $186.21 | $204.17 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $346.74
| Facility | | $147.91 | $245.47 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $346.74 / $389.05
| Professional | | $120.23 | $346.74 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $245.47 / $10,000.00
| Facility | | $138.04 | $245.47 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $245.47 / $10,000.00
| Professional | | $138.04 | $245.47 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $223.87
| Facility | | $112.20 | $186.21 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $204.17
| Professional | | $77.62 | $95.50 | $204.17 |