- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $1,380.38 / $6,165.95
| Facility | | $117.49 | $1,380.38 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $120.23
| Professional | | $25.12 | $47.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $54.95
| Professional | | $21.88 | $43.65 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $389.05
| Facility | | $97.72 | $177.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $54.95
| Professional | | $20.42 | $35.48 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $12.30
| Facility | | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $43.65 / $81.28
| Professional | | $20.42 | $43.65 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $43.65
| Facility | | $21.88 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $95.50
| Professional | | $28.84 | $51.29 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $1,288.25
| Facility | | $54.95 | $56.23 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $77.62 / $3,162.28
| Facility | | $27.54 | $77.62 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $100.00
| Professional | | $26.92 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $33.11
| Professional | | $20.89 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $109.65 / $125.89
| Professional | | $3.02 | $109.65 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $48.98 / $102.33
| Facility | | $23.99 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $95.50
| Professional | | $28.84 | $51.29 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $831.76 / $2,290.87
| Facility | | $114.82 | $831.76 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $42.66 / $83.18
| Professional | | $24.55 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $46.77 / $46.77
| Professional | | $43.65 | $46.77 | $46.77 |