- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $4,265.80 / $10,000.00
| Facility | | $263.03 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $741.31
| Professional | | $173.78 | $218.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $501.19
| Professional | | $162.18 | $204.17 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,258.93 / $8,912.51
| Facility | | $281.84 | $1,258.93 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $4,365.16 / $53,703.18
| Facility | | $34.67 | $4,365.16 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $398.11 / $870.96
| Professional | | $181.97 | $398.11 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $602.56
| Facility | | $169.82 | $213.80 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $223.87 / $331.13
| Professional | | $177.83 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $234.42 / $398.11
| Professional | | $131.83 | $234.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $50,118.72 / $75,857.76
| Facility | | $151.36 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $281.84 / $489.78
| Professional | | $234.42 | $281.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $5,495.41 / $12,302.69
| Facility | | $2,398.83 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $269.15 / $588.84
| Professional | | $169.82 | $269.15 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $199.53 / $354.81
| Facility | | $147.91 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $436.52
| Professional | | $151.36 | $218.78 | $436.52 |