- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $18,620.87
| Facility | | $128.82 | $194.98 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $100.00 / $208.93
| Professional | | $63.10 | $100.00 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $707.95 / $1,445.44
| Facility | | $501.19 | $707.95 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $245.47
| Professional | | $102.33 | $162.18 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $275.42
| Professional | | $79.43 | $144.54 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $141.25 / $251.19
| Facility | | $79.43 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $138.04 / $239.88
| Professional | | $79.43 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $54.95
| Professional | | $32.36 | $33.11 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $186.21 / $204.17
| Facility | | $102.33 | $186.21 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $141.25
| Facility | | $131.83 | $131.83 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $251.19
| Professional | | $95.50 | $147.91 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $741.31 / $1,445.44
| Facility | | $489.78 | $741.31 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $239.88
| Professional | | $100.00 | $162.18 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $954.99 / $2,137.96
| Facility | | $257.04 | $954.99 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $120.23 / $229.09
| Professional | | $81.28 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $131.83 / $165.96
| Professional | | $74.13 | $131.83 | $165.96 |