- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $295.12 / $7,943.28
| Facility | | $100.00 | $295.12 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $104.71 / $2,951.21
| Professional | | $97.72 | $104.71 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $169.82 / $177.83
| Facility | | $147.91 | $169.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $144.54
| Professional | | $79.43 | $79.43 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $380.19
| Facility | | $100.00 | $131.83 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $181.97
| Professional | | $79.43 | $125.89 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $331.13
| Facility | | $100.00 | $100.00 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $371.54
| Facility | | $104.71 | $104.71 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $114.82 / $151.36
| Professional | | $104.71 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $104.71
| Professional | | $64.57 | $100.00 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $144.54
| Facility | | $128.82 | $128.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $323.59
| Professional | | $74.13 | $109.65 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $1,348.96
| Facility | | $100.00 | $100.00 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $446.68
| Professional | | $107.15 | $107.15 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $263.03
| Facility | | $79.43 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $144.54
| Professional | | $100.00 | $109.65 | $144.54 |