- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $199.53 / $199.53
| Facility | | $177.83 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $407.38
| Professional | | $199.53 | $295.12 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $100.00
| Facility | | $31.62 | $39.81 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $1,258.93
| Professional | | $208.93 | $323.59 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $120.23
| Facility | | $52.48 | $85.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $630.96 / $870.96
| Professional | | $467.74 | $630.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $446.68
| Facility | | $338.84 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $346.74
| Professional | | $288.40 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $537.03
| Professional | | $446.68 | $446.68 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $457.09 / $831.76
| Professional | | $398.11 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,995.26 / $1,995.26
| Facility | | $426.58 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $426.58
| Professional | | $54.95 | $54.95 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $288.40 / $489.78
| Facility | | $52.48 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $338.84
| Professional | | $208.93 | $288.40 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $489.78 / $758.58
| Professional | | $446.68 | $489.78 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $151.36 / $269.15
| Facility | | $20.89 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $229.09 / $446.68
| Professional | | $181.97 | $229.09 | $446.68 |