- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $691.83 / $17,782.79
| Facility | | $208.93 | $691.83 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $645.65
| Professional | | $93.33 | $186.21 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $691.83
| Facility | | $257.04 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $218.78 / $331.13
| Professional | | $141.25 | $218.78 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $707.95 / $954.99
| Facility | | $158.49 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $213.80 / $426.58
| Professional | | $112.20 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $371.54
| Facility | | $114.82 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $331.13
| Professional | | $104.71 | $194.98 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $58.88
| Professional | | $32.36 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $275.42 / $288.40
| Facility | | $173.78 | $275.42 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $208.93 / $208.93
| Facility | | $204.17 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $204.17 / $371.54
| Professional | | $128.82 | $204.17 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $691.83
| Facility | | $263.03 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $331.13
| Professional | | $151.36 | $223.87 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,380.38 / $2,691.53
| Facility | | $190.55 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $302.00
| Professional | | $109.65 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $239.88
| Professional | | $93.33 | $169.82 | $239.88 |