- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $2,818.38 / $9,332.54
| Facility | | $218.78 | $2,818.38 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $588.84
| Professional | | $158.49 | $263.03 | $588.84 |
- 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
- $229.09 / $288.40 / $676.08
| Professional | | $229.09 | $288.40 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $6,165.95
| Facility | | $239.88 | $239.88 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $407.38
| Professional | | $239.88 | $239.88 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $295.12 / $50,118.72
| Facility | | $34.67 | $295.12 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $1,000.00
| Professional | | $181.97 | $354.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $204.17 / $512.86
| Facility | | $125.89 | $204.17 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $776.25
| Professional | | $371.54 | $549.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $630.96
| Professional | | $199.53 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $50,118.72 / $75,857.76
| Facility | | $158.49 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $831.76
| Professional | | $338.84 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,398.83 / $4,897.79
| Facility | | $870.96 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $346.74 / $933.25
| Professional | | $165.96 | $346.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $724.44
| Facility | | $141.25 | $208.93 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $691.83
| Professional | | $208.93 | $363.08 | $691.83 |