- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $2,570.40 / $10,715.19
| Facility | | $181.97 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $371.54
| Professional | | $128.82 | $173.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,778.28 / $3,548.13
| Facility | | $707.95 | $1,778.28 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $245.47
| Professional | | $114.82 | $151.36 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $346.74
| Facility | | $125.89 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $158.49
| Professional | | $141.25 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $501.19
| Facility | | $229.09 | $380.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $363.08
| Professional | | $134.90 | $194.98 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $1,318.26
| Facility | | $229.09 | $398.11 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $346.74
| Professional | | $134.90 | $194.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $100.00
| Professional | | $32.36 | $33.11 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $331.13
| Facility | | $100.00 | $100.00 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $346.74
| Professional | | $128.82 | $190.55 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $891.25 / $2,818.38
| Facility | | $199.53 | $891.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $275.42
| Professional | | $114.82 | $165.96 | $275.42 |