- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,570.40 / $10,715.19
| Facility | | $208.93 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $199.53 / $426.58
| Professional | | $165.96 | $199.53 | $426.58 |
- 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
- $109.65 / $141.25 / $239.88
| Professional | | $109.65 | $141.25 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $204.17
| Facility | | $169.82 | $169.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $21,379.62
| Facility | | $204.17 | $281.84 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $371.54
| Professional | | $169.82 | $251.19 | $371.54 |
- 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
- $169.82 / $245.47 / $363.08
| Professional | | $169.82 | $245.47 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $83.18
| Professional | | $32.36 | $33.11 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $151.36
| Facility | | $100.00 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $218.78 / $380.19
| Professional | | $169.82 | $218.78 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $851.14 / $2,951.21
| Facility | | $186.21 | $851.14 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $323.59
| Professional | | $134.90 | $204.17 | $323.59 |