- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $812.83 / $5,128.61
| Facility | | $181.97 | $812.83 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $331.13 / $870.96
| Professional | | $144.54 | $331.13 | $870.96 |
- 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
- $162.18 / $316.23 / $758.58
| Professional | | $162.18 | $316.23 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $812.83
| Facility | | $436.52 | $512.86 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $389.05 / $575.44
| Professional | | $165.96 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $338.84 / $3,801.89
| Facility | | $151.36 | $338.84 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $363.08 / $489.78
| Professional | | $281.84 | $363.08 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $776.25 / $1,778.28
| Facility | | $154.88 | $776.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $977.24
| Professional | | $169.82 | $295.12 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $204.17
| Professional | | $32.36 | $33.11 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $891.25 / $2,344.23
| Facility | | $269.15 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $588.84
| Professional | | $229.09 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $389.05 / $549.54
| Professional | | $190.55 | $389.05 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,951.21 / $2,951.21
| Facility | | $338.84 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $1,202.26
| Professional | | $218.78 | $478.63 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $416.87
| Professional | | $323.59 | $323.59 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $912.01
| Professional | | $371.54 | $707.95 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $2,187.76
| Facility | | $1,000.00 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $245.47 / $588.84
| Professional | | $131.83 | $245.47 | $588.84 |