- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $1,584.89 / $6,165.95
| Facility | | $169.82 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $426.58
| Professional | | $100.00 | $177.83 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $17,378.01 / $45,708.82
| Facility | | $691.83 | $17,378.01 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $281.84
| Professional | | $158.49 | $158.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $302.00
| Professional | | $112.20 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $316.23
| Professional | | $190.55 | $288.40 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $309.03
| Professional | | $151.36 | $218.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,737.80 / $2,818.38
| Facility | | $426.58 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $691.83 / $36,307.81
| Facility | | $660.69 | $691.83 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $1,288.25 / $5,754.40
| Facility | | $144.54 | $1,288.25 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $363.08
| Professional | | $102.33 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $398.11 / $933.25
| Professional | | $151.36 | $398.11 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $309.03
| Facility | | $107.15 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $186.21 / $309.03
| Professional | | $107.15 | $186.21 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,548.82 / $3,890.45
| Facility | | $363.08 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $295.12
| Professional | | $102.33 | $169.82 | $295.12 |