- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $2,570.40 / $10,715.19
| Facility | | $229.09 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $512.86
| Professional | | $147.91 | $229.09 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,089.30 / $3,981.07
| Facility | | $707.95 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $251.19
| Professional | | $117.49 | $158.49 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $177.83
| Facility | | $151.36 | $151.36 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $257.04 / $436.52
| Professional | | $165.96 | $257.04 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $436.52
| Professional | | $154.88 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $93.33
| Professional | | $32.36 | $33.11 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $537.03
| Facility | | $100.00 | $100.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $245.47 / $389.05
| Professional | | $138.04 | $245.47 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,862.09 / $4,073.80
| Facility | | $676.08 | $1,862.09 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $223.87 / $389.05
| Professional | | $131.83 | $223.87 | $389.05 |