- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $407.38 / $891.25
| Facility | | $131.83 | $407.38 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $446.68
| Professional | | $117.49 | $204.17 | $446.68 |
- 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
- $194.98 / $380.19 / $977.24
| Professional | | $194.98 | $380.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $645.65 / $1,023.29
| Facility | | $549.54 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $446.68 / $870.96
| Professional | | $165.96 | $446.68 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $426.58 / $3,801.89
| Facility | | $123.03 | $426.58 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $616.60
| Professional | | $263.03 | $371.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $1,096.48 / $4,168.69
| Facility | | $123.03 | $1,096.48 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $407.38 / $1,258.93
| Professional | | $204.17 | $407.38 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $281.84
| Professional | | $32.36 | $33.11 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $2,951.21 / $3,235.94
| Facility | | $275.42 | $2,951.21 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $478.63 / $812.83
| Professional | | $295.12 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $724.44
| Professional | | $223.87 | $407.38 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,288.25 / $1,288.25
| Facility | | $588.84 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $691.83 / $1,479.11
| Professional | | $165.96 | $691.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $758.58
| Professional | | $436.52 | $436.52 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $691.83 / $1,047.13
| Professional | | $398.11 | $691.83 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,754.23 / $5,011.87
| Facility | | $2,041.74 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $831.76
| Professional | | $141.25 | $295.12 | $831.76 |