- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $2,344.23 / $4,677.35
| Facility | | $194.98 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $245.47 / $1,000.00
| Professional | | $95.50 | $245.47 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $181.97 / $537.03
| Professional | | $89.13 | $181.97 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,862.09 / $3,715.35
| Facility | | $1,445.44 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $309.03 / $630.96
| Professional | | $151.36 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $1,047.13
| Facility | | $707.95 | $870.96 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $691.83
| Professional | | $123.03 | $269.15 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $707.95
| Facility | | $117.49 | $281.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $269.15 / $660.69
| Professional | | $117.49 | $269.15 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $63.10
| Professional | | $32.36 | $33.11 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $489.78 / $501.19
| Facility | | $354.81 | $489.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $354.81 / $630.96
| Professional | | $134.90 | $354.81 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,905.46 / $3,715.35
| Facility | | $1,318.26 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $630.96
| Professional | | $151.36 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,238.72 / $4,570.88
| Facility | | $645.65 | $2,238.72 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $275.42 / $562.34
| Professional | | $125.89 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $181.97 / $398.11
| Professional | | $97.72 | $181.97 | $398.11 |