- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $524.81 / $17,782.79
| Facility | | $102.33 | $524.81 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $213.80
| Professional | | $45.71 | $75.86 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $181.97
| Professional | | $66.07 | $104.71 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $724.44
| Facility | | $416.87 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $229.09
| Professional | | $66.07 | $112.20 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $199.53
| Facility | | $74.13 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $199.53
| Professional | | $74.13 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $52.48
| Professional | | $32.36 | $33.11 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $158.49
| Facility | | $95.50 | $151.36 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $109.65
| Facility | | $102.33 | $102.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $194.98
| Professional | | $67.61 | $109.65 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $1,071.52
| Facility | | $851.14 | $851.14 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $169.82
| Professional | | $67.61 | $104.71 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $645.65 / $5,754.40
| Facility | | $141.25 | $645.65 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $177.83
| Professional | | $64.57 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $81.28 / $114.82
| Professional | | $43.65 | $81.28 | $114.82 |