- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $4,265.80 / $11,748.98
| Facility | | $501.19 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $389.05 / $1,479.11
| Professional | | $239.88 | $389.05 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,365.16 / $8,709.64
| Facility | | $3,090.30 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $602.56 / $912.01
| Professional | | $380.19 | $602.56 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $707.95 / $870.96
| Facility | | $602.56 | $707.95 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $1,000.00
| Professional | | $302.00 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $954.99
| Facility | | $302.00 | $501.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $851.14
| Professional | | $302.00 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $141.25
| Professional | | $32.36 | $33.11 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $691.83 / $741.31
| Facility | | $416.87 | $691.83 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $512.86
| Facility | | $501.19 | $501.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $537.03 / $933.25
| Professional | | $363.08 | $537.03 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,466.84 / $8,709.64
| Facility | | $2,951.21 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $602.56 / $891.25
| Professional | | $371.54 | $602.56 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $4,897.79 / $9,332.54
| Facility | | $891.25 | $4,897.79 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $851.14
| Professional | | $316.23 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $575.44
| Professional | | $281.84 | $457.09 | $575.44 |