- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $707.95 / $3,019.95
| Facility | | $181.97 | $707.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $380.19
| Professional | | $93.33 | $186.21 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $562.34 / $2,818.38
| Facility | | $56.23 | $562.34 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 54 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $380.19
| Professional | | $95.50 | $154.88 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $295.12
| Facility | | $128.82 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $331.13
| Professional | | $128.82 | $223.87 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $186.21 / $346.74
| Professional | | $107.15 | $186.21 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $3,630.78
| Facility | | $104.71 | $151.36 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $173.78 / $223.87
| Professional | | $147.91 | $173.78 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $331.13
| Professional | | $120.23 | $194.98 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $512.86
| Facility | | $162.18 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $181.97 / $229.09
| Professional | | $151.36 | $181.97 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $562.34 / $2,818.38
| Facility | | $56.23 | $562.34 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 54 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $380.19
| Professional | | $95.50 | $154.88 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $309.03 / $489.78
| Facility | | $81.28 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $257.04
| Professional | | $87.10 | $134.90 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,698.24 / $2,818.38
| Facility | | $501.19 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $346.74
| Professional | | $95.50 | $154.88 | $346.74 |