- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $776.25 / $1,995.26
| Facility | | $83.18 | $776.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $302.00 / $1,071.52
| Professional | | $63.10 | $302.00 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $645.65 / $2,454.71
| Professional | | $89.13 | $645.65 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,862.09 / $3,019.95
| Facility | | $1,621.81 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $426.58 / $2,344.23
| Professional | | $81.28 | $426.58 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $602.56 / $2,818.38
| Facility | | $64.57 | $602.56 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $269.15 / $1,584.89
| Professional | | $117.49 | $269.15 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $630.96 / $4,265.80
| Facility | | $64.57 | $630.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,412.54 / $4,265.80
| Professional | | $676.08 | $1,412.54 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $89.13
| Professional | | $32.36 | $33.11 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $3,890.45 / $4,570.88
| Facility | | $134.90 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $912.01 / $2,187.76
| Professional | | $154.88 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $562.34 / $1,862.09
| Professional | | $102.33 | $562.34 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $1,949.84 / $2,884.03
| Facility | | $112.20 | $1,949.84 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $1,000.00 / $4,265.80
| Professional | | $81.28 | $1,000.00 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $2,344.23
| Professional | | $234.42 | $234.42 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $3,019.95
| Professional | | $190.55 | $363.08 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,311.31 / $6,606.93
| Facility | | $2,398.83 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $478.63 / $2,089.30
| Professional | | $72.44 | $478.63 | $2,089.30 |