- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $3,090.30 / $9,120.11
| Facility | | $288.40 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $562.34
| Professional | | $194.98 | $234.42 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $181.97 / $407.38
| Professional | | $154.88 | $181.97 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,258.93 / $4,073.80
| Facility | | $302.00 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,318.26 / $50,118.72
| Facility | | $363.08 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $794.33
| Professional | | $181.97 | $323.59 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $257.04 / $575.44
| Facility | | $89.13 | $257.04 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $501.19
| Professional | | $245.47 | $323.59 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $281.84 / $446.68
| Professional | | $154.88 | $281.84 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $50,118.72 / $75,857.76
| Facility | | $190.55 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $549.54
| Professional | | $257.04 | $398.11 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $5,248.07
| Facility | | $1,348.96 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $776.25
| Professional | | $208.93 | $346.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $630.96
| Facility | | $173.78 | $251.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $512.86
| Professional | | $173.78 | $251.19 | $512.86 |