- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,511.89 / $6,918.31
| Facility | | $199.53 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $154.88 / $501.19
| Professional | | $72.44 | $154.88 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $123.03
| Professional | | $56.23 | $72.44 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,884.03 / $7,943.28
| Facility | | $1,000.00 | $2,884.03 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $257.04
| Professional | | $77.62 | $158.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $380.19
| Professional | 50 | $117.49 | $234.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $97.72
| Facility | | $70.79 | $83.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $213.80 / $380.19
| Professional | | $186.21 | $213.80 | $380.19 |
- 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
- $87.10 / $190.55 / $331.13
| Professional | | $87.10 | $190.55 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,344.23 / $4,168.69
| Facility | | $954.99 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $190.55 / $331.13
| Professional | | $87.10 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $58.88
| Professional | | $32.36 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,548.13
| Facility | | $100.00 | $100.00 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $173.78 / $263.03
| Professional | | $64.57 | $173.78 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,570.40 / $6,606.93
| Facility | | $1,995.26 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $275.42
| Professional | | $74.13 | $147.91 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |