- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $4,897.79
| Facility | | $89.13 | $173.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $239.88
| Professional | | $75.86 | $95.50 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $9,549.93
| Facility | | $2,630.27 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $199.53
| Professional | | $66.07 | $83.18 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $6,165.95
| Facility | | $120.23 | $120.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $120.23 / $218.78
| Professional | | $112.20 | $120.23 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $91.20 / $251.19
| Facility | | $72.44 | $91.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $141.25
| Professional | | $75.86 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $204.17
| Professional | | $70.79 | $109.65 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $218.78
| Professional | | $97.72 | $120.23 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $7,244.36
| Facility | | $1,862.09 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $251.19
| Professional | | $70.79 | $112.20 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $295.12
| Facility | | $67.61 | $89.13 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $263.03
| Professional | | $64.57 | $100.00 | $263.03 |