- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $229.09
| Facility | | $112.20 | $173.78 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $338.84
| Professional | | $87.10 | $112.20 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $457.09
| Facility | | $131.83 | $131.83 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $309.03
| Professional | | $64.57 | $125.89 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $269.15 / $295.12
| Facility | | $251.19 | $269.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $309.03
| Professional | | $91.20 | $131.83 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $724.44
| Facility | | $173.78 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $478.63
| Professional | | $63.10 | $97.72 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $204.17 / $616.60
| Facility | | $112.20 | $204.17 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $1,071.52
| Professional | | $54.95 | $107.15 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $154.88 / $177.83
| Facility | | $46.77 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $177.83
| Professional | | $54.95 | $77.62 | $177.83 |