- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $218.78 / $1,000.00
| Facility | | $85.11 | $218.78 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $162.18 / $501.19
| Professional | | $75.86 | $162.18 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $77.62 / $95.50
| Professional | | $74.13 | $77.62 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $1,513.56
| Facility | | $426.58 | $602.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $263.03
| Professional | | $100.00 | $177.83 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $676.08 / $933.25
| Facility | | $239.88 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $165.96 / $363.08
| Professional | | $85.11 | $165.96 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $239.88 / $912.01
| Professional | | $100.00 | $239.88 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $95.50 / $208.93
| Professional | | $91.20 | $95.50 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $208.93
| Professional | | $32.36 | $33.11 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $776.25 / $1,148.15
| Facility | | $489.78 | $776.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $162.18 / $338.84
| Professional | | $81.28 | $162.18 | $338.84 |