- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $295.12 / $812.83
| Facility | | $134.90 | $295.12 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $446.68
| Professional | | $131.83 | $208.93 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $691.83
| Professional | | $181.97 | $281.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $691.83 / $1,096.48
| Facility | | $588.84 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $501.19 / $1,023.29
| Professional | | $223.87 | $501.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $275.42 / $3,162.28
| Facility | | $131.83 | $275.42 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $616.60
| Professional | | $263.03 | $407.38 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $288.40 / $3,981.07
| Facility | | $131.83 | $288.40 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $457.09 / $1,659.59
| Professional | | $218.78 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $181.97
| Professional | | $32.36 | $33.11 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,951.21 / $3,235.94
| Facility | | $281.84 | $2,951.21 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $691.83
| Professional | | $275.42 | $467.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $478.63 / $794.33
| Professional | | $281.84 | $478.63 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $2,951.21
| Facility | | $302.00 | $575.44 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,047.13 / $1,737.80
| Professional | | $257.04 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $724.44
| Professional | | $457.09 | $457.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $912.01 / $1,412.54
| Professional | | $302.00 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,818.38 / $5,128.61
| Facility | | $2,238.72 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $741.31
| Professional | | $151.36 | $281.84 | $741.31 |