- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,000.00 / $4,168.69
| Facility | | $316.23 | $1,000.00 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $323.59 / $891.25
| Professional | | $165.96 | $323.59 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $426.58
| Professional | | $173.78 | $309.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,467.37 / $7,585.78
| Facility | | $2,570.40 | $3,467.37 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $288.40
| Professional | | $144.54 | $144.54 | $288.40 |
- 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
- $478.63 / $501.19 / $724.44
| Professional | | $478.63 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $478.63
| Professional | | $177.83 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $467.74 / $512.86
| Professional | | $309.03 | $467.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $489.78
| Professional | | $213.80 | $338.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $851.14 / $1,584.89
| Facility | | $478.63 | $851.14 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $346.74
| Professional | | $190.55 | $295.12 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $3,019.95 / $4,786.30
| Facility | | $275.42 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $288.40
| Professional | | $144.54 | $245.47 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $831.76 / $4,786.30
| Facility | | $239.88 | $831.76 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $537.03
| Professional | | $169.82 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $524.81 / $1,202.26
| Professional | | $234.42 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $295.12
| Facility | | $112.20 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $181.97 / $416.87
| Professional | | $112.20 | $181.97 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $977.24 / $3,890.45
| Facility | | $363.08 | $977.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $467.74
| Professional | | $162.18 | $269.15 | $467.74 |