- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $5,128.61 / $11,748.98
| Facility | | $331.13 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $223.87 / $1,122.02
| Professional | | $177.83 | $223.87 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,754.23 / $7,244.36
| Facility | | $1,000.00 | $2,754.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $323.59
| Professional | | $158.49 | $199.53 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $213.80 / $1,737.80
| Facility | | $186.21 | $213.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $234.42
| Professional | | $208.93 | $208.93 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $602.56 / $2,398.83
| Facility | | $208.93 | $602.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $457.09
| Professional | | $186.21 | $263.03 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $724.44 / $2,818.38
| Facility | | $338.84 | $724.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $416.87
| Professional | | $186.21 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $4,073.80
| Facility | | $100.00 | $100.00 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $213.80 / $407.38
| Professional | | $181.97 | $213.80 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $4,168.69 / $7,943.28
| Facility | | $870.96 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $346.74
| Professional | | $151.36 | $208.93 | $346.74 |