- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $467.74 / $776.25
| Facility | | $165.96 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $144.54 / $524.81
| Professional | | $131.83 | $144.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,174.90 / $5,011.87
| Facility | | $870.96 | $1,174.90 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $602.56
| Facility | | $173.78 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $398.11
| Professional | | $104.71 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $239.88
| Professional | | $123.03 | $158.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $457.09
| Professional | | $190.55 | $288.40 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $1,047.13
| Facility | | $223.87 | $223.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $467.74 / $602.56
| Facility | | $151.36 | $467.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $144.54 / $204.17
| Professional | | $131.83 | $144.54 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $269.15
| Facility | | $114.82 | $114.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $1,230.27
| Professional | | $114.82 | $177.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $213.80
| Facility | | $144.54 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $263.03
| Professional | | $74.13 | $107.15 | $263.03 |