- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,090.30 / $8,912.51
| Facility | | $323.59 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $724.44
| Professional | | $177.83 | $295.12 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $724.44
| Professional | | $234.42 | $309.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,698.24 / $6,165.95
| Facility | | $281.84 | $1,698.24 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $489.78
| Professional | | $281.84 | $281.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $3,235.94 / $53,703.18
| Facility | | $338.84 | $3,235.94 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $1,000.00
| Professional | | $208.93 | $389.05 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $524.81
| Facility | | $128.82 | $208.93 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $758.58
| Professional | | $346.74 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $630.96
| Professional | | $245.47 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $50,118.72 / $75,857.76
| Facility | | $234.42 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $407.38 / $537.03
| Professional | | $398.11 | $407.38 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,398.83 / $4,897.79
| Facility | | $1,318.26 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $316.23 / $741.31
| Professional | | $147.91 | $316.23 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $776.25
| Facility | | $162.18 | $213.80 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $724.44
| Professional | | $245.47 | $389.05 | $724.44 |