- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $1,000.00 / $3,801.89
| Facility | | $102.33 | $1,000.00 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $104.71 / $309.03
| Professional | | $45.71 | $104.71 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $107.15 / $1,778.28
| Professional | | $45.71 | $107.15 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $114.82
| Facility | | $50.12 | $50.12 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $100.00 / $208.93
| Professional | | $50.12 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $114.82 / $229.09
| Professional | | $53.70 | $114.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $162.18
| Facility | | $19.95 | $40.74 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $89.13 / $162.18
| Professional | | $47.86 | $89.13 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $102.33 / $223.87
| Professional | | $45.71 | $102.33 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $398.11 / $4,786.30
| Facility | | $309.03 | $398.11 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $158.49
| Professional | | $109.65 | $144.54 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $107.15 / $1,778.28
| Professional | | $45.71 | $107.15 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,122.02 / $24,547.09
| Facility | | $79.43 | $1,122.02 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $239.88
| Professional | | $48.98 | $112.20 | $239.88 |