- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $1,412.54
| Facility | | $165.96 | $416.87 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $331.13
| Professional | | $162.18 | $218.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.50 / $169.82
| Professional | | $5.01 | $5.50 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $275.42 / $275.42
| Facility | | $79.43 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $512.86 / $1,230.27
| Facility | | $181.97 | $512.86 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $426.58
| Professional | | $123.03 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,041.74 / $2,041.74
| Professional | | $1,380.38 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $537.03
| Facility | | $190.55 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $234.42 / $416.87
| Professional | | $144.54 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $295.12 / $588.84
| Professional | | $275.42 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $776.25
| Facility | | $190.55 | $288.40 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $426.58
| Professional | | $125.89 | $194.98 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $275.42 / $331.13
| Facility | | $114.82 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $275.42
| Professional | | $114.82 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $275.42
| Professional | | $107.15 | $141.25 | $275.42 |