- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $3,090.30 / $10,000.00
| Facility | | $512.86 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $263.03
| Professional | | $100.00 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $100.00 / $144.54
| Professional | | $89.13 | $100.00 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $4,168.69 / $12,302.69
| Facility | | $309.03 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $177.83
| Professional | | $107.15 | $134.90 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $398.11
| Facility | | $173.78 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $309.03
| Professional | | $100.00 | $162.18 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,388.44 / $7,585.78
| Facility | | $2,454.71 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $194.98
| Professional | | $107.15 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $186.21
| Professional | | $32.36 | $33.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,290.87 / $5,011.87
| Facility | | $537.03 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $316.23
| Professional | | $100.00 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $158.49
| Professional | | $77.62 | $117.49 | $158.49 |