- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $2,238.72 / $10,715.19
| Facility | | $100.00 | $2,238.72 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $102.33 / $257.04
| Professional | | $28.18 | $102.33 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $4,466.84
| Facility | | $707.95 | $2,137.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.02 / $63.10
| Professional | | $28.18 | $38.02 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $33.88
| Facility | | $28.84 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $21,379.62
| Facility | | $48.98 | $48.98 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $100.00 / $213.80
| Professional | | $32.36 | $100.00 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $758.58 / $21,379.62
| Facility | | $138.04 | $758.58 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $102.33 / $218.78
| Professional | | $32.36 | $102.33 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $33.11
| Professional | | $21.88 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $186.21
| Facility | | $100.00 | $100.00 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $93.33 / $173.78
| Professional | | $26.92 | $93.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $891.25 / $2,951.21
| Facility | | $229.09 | $891.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $83.18 / $190.55
| Professional | | $26.92 | $83.18 | $190.55 |