- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $389.05 / $1,023.29
| Facility | | $162.18 | $389.05 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $489.78
| Professional | | $173.78 | $223.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $288.40 / $501.19
| Facility | | $251.19 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $371.54
| Professional | | $109.65 | $141.25 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $389.05
| Facility | | $218.78 | $316.23 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $331.13 / $371.54
| Professional | | $275.42 | $331.13 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $1,584.89
| Facility | | $269.15 | $363.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $549.54
| Professional | | $125.89 | $239.88 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $181.97 / $1,584.89
| Facility | | $177.83 | $181.97 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $616.60
| Professional | | $125.89 | $151.36 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $245.47 / $338.84
| Professional | | $204.17 | $245.47 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $630.96
| Professional | | $234.42 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $416.87
| Facility | | $245.47 | $275.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $331.13
| Professional | | $114.82 | $165.96 | $331.13 |