- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $18,620.87
| Facility | | $208.93 | $363.08 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $363.08
| Professional | | $100.00 | $151.36 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,621.81 / $3,388.44
| Facility | | $758.58 | $1,621.81 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $371.54
| Professional | | $151.36 | $223.87 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $204.17
| Facility | | $134.90 | $134.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $234.42 / $446.68
| Professional | | $144.54 | $234.42 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $251.19 / $426.58
| Facility | | $151.36 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $389.05
| Professional | | $154.88 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $323.59
| Facility | | $194.98 | $302.00 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $218.78
| Facility | | $102.33 | $213.80 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $398.11
| Professional | | $151.36 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,659.59 / $3,388.44
| Facility | | $1,148.15 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $363.08
| Professional | | $151.36 | $223.87 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,344.23 / $4,570.88
| Facility | | $676.08 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $371.54
| Professional | | $144.54 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $251.19
| Professional | | $102.33 | $194.98 | $251.19 |