- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,778.28 / $6,025.60
| Facility | | $269.15 | $1,778.28 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $630.96
| Professional | | $147.91 | $269.15 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $263.03 / $346.74
| Professional | | $177.83 | $263.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $257.04 / $977.24
| Facility | | $147.91 | $257.04 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $407.38
| Professional | | $154.88 | $257.04 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $912.01
| Facility | | $302.00 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $269.15 / $436.52
| Professional | | $91.20 | $269.15 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $162.18 / $269.15
| Facility | | $144.54 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $426.58
| Professional | | $186.21 | $295.12 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $2,754.23
| Facility | | $54.95 | $56.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,344.23 / $2,344.23
| Professional | | $2,041.74 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $323.59 / $3,630.78
| Facility | | $154.88 | $323.59 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $549.54
| Professional | | $151.36 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $229.09
| Professional | | $32.36 | $33.11 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $398.11
| Facility | | $147.91 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $457.09
| Professional | | $190.55 | $302.00 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $851.14 / $2,290.87
| Facility | | $173.78 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $338.84
| Professional | | $147.91 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $288.40
| Professional | | $269.15 | $269.15 | $288.40 |