- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $5,128.61 / $9,549.93
| Facility | | $363.08 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $446.68 / $1,148.15
| Professional | | $186.21 | $446.68 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $309.03 / $512.86
| Professional | | $169.82 | $309.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,011.87 / $10,232.93
| Facility | | $3,630.78 | $5,011.87 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $630.96 / $1,096.48
| Professional | | $309.03 | $630.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $741.31 / $2,041.74
| Facility | | $331.13 | $741.31 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | 22 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $1,288.25
| Professional | | $234.42 | $512.86 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $537.03 / $1,862.09
| Facility | | $245.47 | $537.03 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $467.74 / $1,258.93
| Professional | | $229.09 | $467.74 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $123.03
| Professional | | $32.36 | $33.11 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $912.01 / $954.99
| Facility | | $380.19 | $912.01 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $691.83 / $1,230.27
| Facility | | $676.08 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $676.08 / $1,230.27
| Professional | | $263.03 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,248.07 / $10,232.93
| Facility | | $3,467.37 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $630.96 / $1,096.48
| Professional | | $309.03 | $630.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $5,495.41 / $10,715.19
| Facility | | $870.96 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $436.52 / $1,000.00
| Professional | | $239.88 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $354.81 / $794.33
| Professional | | $186.21 | $354.81 | $794.33 |