- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,570.40 / $10,715.19
| Facility | | $281.84 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $933.25
| Professional | | $162.18 | $257.04 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $398.11
| Professional | | $141.25 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $21,379.62
| Facility | | $165.96 | $165.96 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $489.78
| Professional | | $165.96 | $263.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $21,379.62
| Facility | | $165.96 | $165.96 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $512.86
| Professional | | $165.96 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $194.98
| Facility | | $100.00 | $100.00 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $489.78
| Professional | | $151.36 | $269.15 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $891.25 / $2,951.21
| Facility | | $239.88 | $891.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $223.87 / $371.54
| Professional | | $147.91 | $223.87 | $371.54 |