- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $1,318.26 / $3,090.30
| Facility | | $158.49 | $1,318.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $371.54 / $602.56
| Professional | | $93.33 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $269.15 / $346.74
| Professional | | $50.12 | $269.15 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $109.65
| Facility | | $26.92 | $26.92 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $109.65 / $134.90
| Professional | | $26.92 | $109.65 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $426.58
| Facility | | $147.91 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $234.42 / $501.19
| Professional | | $77.62 | $234.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $218.78
| Facility | | $97.72 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38,018.94 / $38,018.94 / $38,018.94
| Professional | | $38,018.94 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $724.44
| Professional | | $524.81 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $524.81
| Facility | | $138.04 | $190.55 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $489.78 / $42,657.95
| Professional | | $50.12 | $489.78 | $42,657.95 |