- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $194.98 / $549.54
| Facility | | $144.54 | $194.98 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $426.58
| Professional | | $125.89 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | 25 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $549.54
| Professional | | $141.25 | $190.55 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $239.88
| Facility | | $120.23 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $436.52
| Professional | | $162.18 | $234.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $1,023.29
| Facility | | $512.86 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $346.74 / $660.69
| Professional | | $89.13 | $346.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $275.42
| Facility | | $158.49 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $467.74
| Professional | | $229.09 | $316.23 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $275.42
| Facility | | $158.49 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $1,071.52
| Professional | | $128.82 | $229.09 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $169.82
| Professional | | $32.36 | $33.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $501.19
| Professional | | $144.54 | $213.80 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $524.81
| Professional | | $208.93 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $1,071.52
| Facility | | $199.53 | $398.11 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $218.78 / $1,230.27
| Professional | | $63.10 | $218.78 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $281.84
| Professional | | $251.19 | $251.19 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $602.56
| Professional | | $229.09 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $162.18 / $213.80
| Facility | | $158.49 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $223.87 / $537.03
| Professional | | $95.50 | $223.87 | $537.03 |