- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $501.19 / $1,258.93
| Facility | | $223.87 | $501.19 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $501.19 / $1,096.48
| Professional | | $125.89 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,148.15 / $2,344.23
| Professional | | $199.53 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,344.23 / $3,801.89
| Facility | | $1,737.80 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $512.86 / $2,511.89
| Professional | | $162.18 | $512.86 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $1,258.93
| Facility | | $107.15 | $223.87 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $457.09 / $1,905.46
| Professional | | $251.19 | $457.09 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $251.19 / $1,288.25
| Facility | | $107.15 | $251.19 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,513.56 / $5,011.87
| Professional | | $691.83 | $1,513.56 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $269.15
| Facility | | $173.78 | $173.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,000.00 / $2,041.74
| Professional | | $275.42 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $831.76 / $2,290.87
| Professional | | $208.93 | $831.76 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,380.38 / $2,238.72
| Facility | | $213.80 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $1,318.26 / $5,011.87
| Professional | | $144.54 | $1,318.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $954.99
| Professional | | $158.49 | $158.49 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $467.74 / $2,630.27
| Professional | | $173.78 | $467.74 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $870.96 / $1,148.15
| Facility | | $489.78 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $501.19 / $1,778.28
| Professional | | $128.82 | $501.19 | $1,778.28 |