- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $1,905.46
| Facility | | $100.00 | $165.96 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $436.52
| Professional | | $102.33 | $177.83 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $346.74 / $741.31
| Professional | | $181.97 | $346.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $588.84 / $954.99
| Facility | | $512.86 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $575.44
| Professional | | $128.82 | $269.15 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $338.84 / $3,388.44
| Facility | | $120.23 | $338.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $346.74 / $562.34
| Professional | | $223.87 | $346.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $338.84 / $1,659.59
| Facility | | $120.23 | $338.84 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $323.59 / $912.01
| Professional | | $177.83 | $323.59 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $371.54
| Professional | | $32.36 | $33.11 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $891.25 / $2,344.23
| Facility | | $257.04 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $416.87 / $549.54
| Professional | | $208.93 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $354.81 / $602.56
| Professional | | $199.53 | $354.81 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $3,890.45 / $3,890.45
| Facility | | $316.23 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $1,380.38
| Professional | | $128.82 | $257.04 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $354.81
| Professional | | $223.87 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $812.83
| Professional | | $275.42 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $2,187.76
| Facility | | $977.24 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $190.55 / $831.76
| Professional | | $91.20 | $190.55 | $831.76 |