- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $165.96 / $181.97
| Facility | | $162.18 | $165.96 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $208.93 / $398.11
| Professional | | $181.97 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $281.84
| Professional | | $190.55 | $234.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $229.09
| Facility | | $144.54 | $181.97 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $208.93 / $234.42
| Professional | | $181.97 | $208.93 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $331.13
| Facility | | $194.98 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $275.42 / $501.19
| Professional | | $181.97 | $275.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,023.29 / $1,819.70
| Facility | | $512.86 | $1,023.29 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $281.84
| Professional | | $147.91 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $173.78 / $354.81
| Professional | | $32.36 | $173.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $426.58
| Professional | | $165.96 | $234.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $158.49 / $229.09
| Professional | | $154.88 | $158.49 | $229.09 |