- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $3,019.95 / $5,248.07
| Facility | | $257.04 | $3,019.95 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $316.23 / $1,000.00
| Professional | | $151.36 | $316.23 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $3,801.89 / $28,840.32
| Facility | | $354.81 | $3,801.89 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $354.81 / $954.99
| Professional | | $162.18 | $354.81 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $407.38
| Facility | | $173.78 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $363.08 / $794.33
| Professional | | $173.78 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $380.19 / $812.83
| Professional | | $190.55 | $380.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $3,311.31
| Facility | | $83.18 | $169.82 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $501.19
| Professional | | $181.97 | $331.13 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,630.78 / $8,511.38
| Facility | | $1,778.28 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $354.81 / $776.25
| Professional | | $162.18 | $354.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,570.40 / $4,265.80
| Facility | | $1,071.52 | $2,570.40 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $524.81
| Professional | | $338.84 | $501.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $3,801.89 / $28,840.32
| Facility | | $354.81 | $3,801.89 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $354.81 / $954.99
| Professional | | $162.18 | $354.81 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,630.78 / $8,511.38
| Facility | | $1,445.44 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $363.08 / $812.83
| Professional | | $169.82 | $363.08 | $812.83 |