- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $2,511.89 / $10,715.19
| Facility | | $151.36 | $2,511.89 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $213.80 / $457.09
| Professional | | $77.62 | $213.80 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,884.03 / $5,888.44
| Facility | | $954.99 | $2,884.03 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $302.00
| Professional | | $75.86 | $112.20 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $1,737.80
| Facility | | $75.86 | $85.11 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $95.50
| Professional | | $83.18 | $83.18 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $398.11 / $2,041.74
| Facility | | $134.90 | $398.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $223.87 / $457.09
| Professional | | $85.11 | $223.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $457.09 / $2,818.38
| Facility | | $134.90 | $457.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $223.87 / $426.58
| Professional | | $85.11 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $57.54
| Professional | | $32.36 | $33.11 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,388.44
| Facility | | $100.00 | $100.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $239.88 / $446.68
| Professional | | $77.62 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $4,168.69 / $7,413.10
| Facility | | $870.96 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $173.78 / $363.08
| Professional | | $74.13 | $173.78 | $363.08 |