- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,819.70 / $3,715.35
| Facility | | $194.98 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $676.08
| Professional | | $131.83 | $218.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $724.44 / $19,498.45
| Facility | | $154.88 | $724.44 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $245.47 / $1,380.38
| Professional | | $141.25 | $245.47 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $371.54
| Facility | | $165.96 | $165.96 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $501.19
| Professional | | $181.97 | $281.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $446.68 / $501.19
| Facility | | $218.78 | $446.68 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $257.04 / $524.81
| Professional | | $151.36 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $3,311.31
| Facility | | $123.03 | $190.55 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $398.11
| Professional | | $190.55 | $269.15 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,819.70 / $3,467.37
| Facility | | $229.09 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $501.19
| Professional | | $154.88 | $263.03 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $281.84 / $676.08
| Facility | | $269.15 | $281.84 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $724.44 / $19,498.45
| Facility | | $154.88 | $724.44 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $245.47 / $1,380.38
| Professional | | $141.25 | $245.47 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,000.00 / $2,754.23
| Facility | | $229.09 | $1,000.00 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $524.81
| Professional | | $144.54 | $263.03 | $524.81 |