- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $1,737.80 / $2,884.03
| Facility | | $223.87 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $295.12
| Professional | | $169.82 | $208.93 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $323.59 / $588.84
| Professional | | $0.02 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $537.03 / $588.84
| Professional | | $416.87 | $537.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $691.83 / $1,000.00
| Facility | | $346.74 | $691.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $933.25
| Professional | | $275.42 | $346.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $288.40
| Professional | | $194.98 | $234.42 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $371.54 / $602.56
| Facility | | $204.17 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $181.97 / $380.19
| Facility | | $67.61 | $181.97 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $218.78 / $446.68
| Professional | | $72.44 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $588.84 / $851.14
| Facility | | $288.40 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $758.58
| Professional | | $245.47 | $436.52 | $758.58 |