- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $194.98 / $10,715.19
| Facility | | $53.70 | $194.98 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $109.65 / $263.03
| Professional | | $45.71 | $109.65 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $229.09
| Professional | | $93.33 | $109.65 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $141.25
| Professional | | $44.67 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $123.03 / $128.82
| Professional | | $109.65 | $123.03 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $66.07
| Facility | | $38.90 | $63.10 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $251.19
| Professional | | $120.23 | $147.91 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $102.33 / $186.21
| Professional | | $51.29 | $102.33 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $21,379.62
| Facility | | $158.49 | $158.49 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $107.15 / $177.83
| Professional | | $56.23 | $107.15 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $48.98
| Professional | | $32.36 | $33.11 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $245.47
| Facility | | $100.00 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $91.20 / $173.78
| Professional | | $44.67 | $91.20 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $870.96 / $2,951.21
| Facility | | $151.36 | $870.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $165.96
| Professional | | $45.71 | $87.10 | $165.96 |