- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $2,951.21 / $10,715.19
| Facility | | $169.82 | $2,951.21 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $316.23
| Professional | | $104.71 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,995.26 / $3,715.35
| Facility | | $776.25 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $218.78
| Professional | | $89.13 | $128.82 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $114.82 / $154.88
| Facility | | $102.33 | $114.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $128.82
| Professional | | $112.20 | $112.20 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $616.60
| Facility | | $114.82 | $181.97 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $338.84
| Professional | | $109.65 | $177.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $489.78 / $1,659.59
| Facility | | $173.78 | $489.78 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $316.23
| Professional | | $112.20 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $53.70
| Professional | | $32.36 | $33.11 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $144.54
| Facility | | $100.00 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $263.03
| Professional | | $100.00 | $158.49 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $707.95 / $2,818.38
| Facility | | $177.83 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $239.88
| Professional | | $93.33 | $144.54 | $239.88 |