- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $295.12 / $18,620.87
| Facility | | $117.49 | $295.12 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $134.90 / $501.19
| Professional | | $57.54 | $134.90 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $295.12
| Professional | | $104.71 | $186.21 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $537.03 / $1,096.48
| Facility | | $371.54 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $316.23
| Professional | | $83.18 | $162.18 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $218.78
| Facility | | $144.54 | $144.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $169.82 / $389.05
| Professional | | $81.28 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $354.81
| Facility | | $100.00 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $331.13
| Professional | | $100.00 | $158.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $223.87 / $269.15
| Facility | | $131.83 | $223.87 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $186.21
| Facility | | $112.20 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $338.84
| Professional | | $85.11 | $186.21 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $1,096.48
| Facility | | $371.54 | $549.54 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $288.40
| Professional | | $83.18 | $162.18 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $707.95 / $1,584.89
| Facility | | $186.21 | $707.95 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $302.00
| Professional | | $81.28 | $141.25 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $102.33 / $194.98
| Professional | | $54.95 | $102.33 | $194.98 |