- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $151.36 / $398.11
| Facility | | $46.77 | $151.36 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $104.71
| Professional | | $51.29 | $66.07 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $1,023.29
| Facility | | $295.12 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $63.10 / $79.43
| Professional | | $27.54 | $63.10 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $70.79
| Facility | | $64.57 | $64.57 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $229.09 / $758.58
| Facility | | $131.83 | $229.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $190.55
| Professional | | $57.54 | $87.10 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Professional | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $199.53
| Facility | | $60.26 | $95.50 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $154.88
| Professional | | $51.29 | $79.43 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $33.11 / $56.23
| Professional | | $17.78 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $302.00
| Professional | | $123.03 | $169.82 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $229.09
| Facility | | $60.26 | $100.00 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $186.21
| Professional | | $57.54 | $87.10 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $229.09 / $524.81
| Facility | | $93.33 | $229.09 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $162.18
| Professional | | $63.10 | $87.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $69.18 / $81.28
| Professional | | $66.07 | $69.18 | $81.28 |