- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $933.25 / $3,630.78
| Facility | | $158.49 | $933.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $288.40 / $630.96
| Professional | | $154.88 | $288.40 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $758.58 / $2,818.38
| Facility | | $56.23 | $758.58 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 54 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $630.96
| Professional | | $162.18 | $269.15 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $501.19
| Facility | | $218.78 | $218.78 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $562.34
| Professional | | $218.78 | $371.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $316.23 / $575.44
| Professional | | $186.21 | $316.23 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $251.19 / $3,630.78
| Facility | | $177.83 | $251.19 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $295.12 / $380.19
| Professional | | $251.19 | $295.12 | $380.19 |
- 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
- $208.93 / $323.59 / $575.44
| Professional | | $208.93 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $457.09 / $602.56
| Facility | | $162.18 | $457.09 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $323.59 / $588.84
| Professional | | $269.15 | $323.59 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $758.58 / $2,818.38
| Facility | | $56.23 | $758.58 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 54 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $630.96
| Professional | | $162.18 | $269.15 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,698.24 / $2,818.38
| Facility | | $562.34 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $588.84
| Professional | | $177.83 | $275.42 | $588.84 |