- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $245.47 / $588.84
| Facility | | $141.25 | $245.47 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $295.12
| Professional | | $100.00 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $234.42 / $416.87
| Professional | | $120.23 | $234.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $602.56
| Facility | | $194.98 | $194.98 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $323.59
| Professional | | $117.49 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $363.08
| Professional | | $229.09 | $229.09 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $281.84
| Facility | | $104.71 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $354.81
| Professional | | $144.54 | $257.04 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $724.44 / $1,949.84
| Facility | | $213.80 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $151.36 / $275.42
| Professional | | $93.33 | $151.36 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,445.44
| Professional | | $1,202.26 | $1,202.26 | $1,445.44 |