- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $380.19 / $6,606.93
| Facility | | $194.98 | $380.19 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $173.78 / $524.81
| Professional | | $95.50 | $173.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | 22 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $426.58
| Professional | | $141.25 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $208.93 / $398.11
| Professional | | $158.49 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $229.09 / $407.38
| Facility | | $117.49 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $398.11
| Professional | | $144.54 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | 22 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $331.13
| Facility | | $186.21 | $302.00 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $363.08
| Facility | | $112.20 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $239.88 / $416.87
| Professional | | $79.43 | $239.88 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,258.93 / $1,621.81
| Facility | | $891.25 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $269.15 / $426.58
| Professional | | $181.97 | $269.15 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,778.28 / $5,128.61
| Facility | | $676.08 | $1,778.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $389.05
| Professional | | $134.90 | $239.88 | $389.05 |