- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $316.23 / $380.19
| Facility | | $213.80 | $316.23 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $380.19
| Professional | | $128.82 | $162.18 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $2,137.96
| Facility | | $758.58 | $1,071.52 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $281.84 / $416.87
| Professional | | $177.83 | $281.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $478.63
| Professional | | $158.49 | $263.03 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $1,479.11
| Facility | | $173.78 | $302.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $416.87
| Professional | | $173.78 | $288.40 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $295.12
| Facility | | $194.98 | $269.15 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $208.93
| Facility | | $204.17 | $204.17 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $426.58
| Professional | | $208.93 | $295.12 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $2,137.96
| Facility | | $724.44 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $281.84 / $389.05
| Professional | | $177.83 | $281.84 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,513.56 / $2,754.23
| Facility | | $1,148.15 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $389.05
| Professional | | $147.91 | $186.21 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $208.93 / $338.84
| Professional | | $177.83 | $208.93 | $338.84 |