- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $120.23 / $691.83
| Facility | | $30.20 | $120.23 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $316.23
| Professional | | $56.23 | $100.00 | $316.23 |
- 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
- $75.86 / $117.49 / $281.84
| Professional | | $75.86 | $117.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $72.44 / $95.50
| Facility | | $66.07 | $72.44 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $251.19 / $407.38
| Facility | | $218.78 | $251.19 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $204.17 / $380.19
| Professional | | $83.18 | $204.17 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $3,162.28
| Facility | | $63.10 | $114.82 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $229.09
| Professional | | $107.15 | $154.88 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $120.23 / $1,584.89
| Facility | | $64.57 | $120.23 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $169.82 / $602.56
| Professional | | $85.11 | $169.82 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $891.25 / $2,344.23
| Facility | | $120.23 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $257.04
| Professional | | $102.33 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $288.40
| Professional | | $109.65 | $181.97 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $1,288.25
| Facility | | $104.71 | $194.98 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $380.19 / $602.56
| Professional | | $104.71 | $380.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $257.04
| Professional | | $186.21 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $371.54 / $524.81
| Professional | | $125.89 | $371.54 | $524.81 |
- 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
- $75.86 / $165.96 / $467.74
| Professional | | $75.86 | $165.96 | $467.74 |