- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $524.81 / $17,782.79
| Facility | | $223.87 | $524.81 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $173.78 / $501.19
| Professional | | $97.72 | $173.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,659.59 / $3,388.44
| Facility | | $1,174.90 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $263.03 / $457.09
| Professional | | $147.91 | $263.03 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $316.23
| Facility | | $208.93 | $208.93 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $562.34
| Professional | | $144.54 | $263.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $269.15 / $537.03
| Facility | | $169.82 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $269.15 / $478.63
| Professional | | $169.82 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $354.81 / $389.05
| Facility | | $186.21 | $354.81 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $275.42
| Facility | | $154.88 | $263.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $275.42 / $501.19
| Professional | | $154.88 | $275.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,737.80 / $3,388.44
| Facility | | $1,148.15 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $257.04 / $416.87
| Professional | | $147.91 | $257.04 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,344.23 / $5,011.87
| Facility | | $645.65 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $229.09 / $426.58
| Professional | | $144.54 | $229.09 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $213.80 / $316.23
| Professional | | $112.20 | $213.80 | $316.23 |