- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $2,290.87 / $17,782.79
| Facility | | $112.20 | $2,290.87 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $169.82
| Professional | | $56.23 | $79.43 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,073.80 / $8,317.64
| Facility | | $3,090.30 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $177.83
| Professional | | $91.20 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $467.74 / $630.96
| Facility | | $63.10 | $467.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $239.88
| Professional | | $64.57 | $112.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $239.88
| Facility | | $67.61 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $186.21
| Professional | | $64.57 | $114.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $48.98
| Professional | | $32.36 | $33.11 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $162.18
| Facility | | $95.50 | $147.91 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $102.33
| Facility | | $64.57 | $100.00 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $186.21
| Professional | | $81.28 | $114.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,265.80 / $8,317.64
| Facility | | $2,884.03 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $177.83
| Professional | | $91.20 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $4,466.84 / $8,709.64
| Facility | | $812.83 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $169.82
| Professional | | $69.18 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $112.20
| Professional | | $60.26 | $79.43 | $112.20 |