- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $524.81 / $17,782.79
| Facility | | $141.25 | $524.81 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $141.25 / $371.54
| Professional | | $70.79 | $141.25 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $1,348.96
| Facility | | $512.86 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $380.19
| Professional | | $109.65 | $194.98 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $251.19
| Facility | | $151.36 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $457.09
| Professional | | $109.65 | $190.55 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $426.58
| Facility | | $109.65 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $389.05
| Professional | | $109.65 | $177.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $44.67
| Professional | | $32.36 | $33.11 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $229.09 / $316.23
| Facility | | $107.15 | $229.09 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $223.87 / $407.38
| Professional | | $97.72 | $223.87 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $691.83 / $1,348.96
| Facility | | $457.09 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $380.19
| Professional | | $109.65 | $190.55 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $870.96 / $1,995.26
| Facility | | $229.09 | $870.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $165.96 / $363.08
| Professional | | $95.50 | $165.96 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $245.47
| Professional | | $67.61 | $128.82 | $245.47 |