- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $338.84 / $18,620.87
| Facility | | $269.15 | $338.84 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $501.19
| Professional | | $199.53 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Professional | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $177.83
| Facility | | $169.82 | $169.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $190.55 / $50,118.72
| Facility | | $181.97 | $190.55 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $1,513.56
| Professional | | $295.12 | $295.12 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $338.84
| Facility | | $83.18 | $147.91 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $147.91
| Professional | | $83.18 | $83.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $165.96 / $165.96
| Facility | | $83.18 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $85.11 / $165.96
| Professional | | $83.18 | $85.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $50,118.72 / $75,857.76
| Facility | | $616.60 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $165.96 / $251.19
| Facility | | $151.36 | $165.96 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $288.40 / $389.05
| Professional | | $158.49 | $288.40 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $173.78
| Facility | | $83.18 | $131.83 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $85.11 / $199.53
| Professional | | $83.18 | $85.11 | $199.53 |