- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $104.71 / $234.42
| Facility | | $19.50 | $104.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $25.12 / $61.66
| Professional | | $12.88 | $25.12 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.00 / $26.30 / $87.10
| Professional | 25 | $10.00 | $26.30 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $23.44
| Professional | | $13.18 | $17.38 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $1,000.00
| Facility | | $104.71 | $194.98 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $37.15
| Professional | | $15.49 | $18.20 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $23.99 / $40.74
| Professional | | $15.49 | $23.99 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $758.58
| Facility | | $18.20 | $25.70 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $39.81
| Professional | | $14.45 | $22.91 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Facility | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $22.39 / $30.90
| Professional | | $18.20 | $22.39 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $41.69
| Professional | | $15.49 | $21.88 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $158.49
| Facility | | $75.86 | $120.23 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $79.43
| Professional | | $15.85 | $22.39 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $218.78 / $549.54
| Facility | | $123.03 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $44.67
| Professional | | $15.49 | $18.20 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $204.17 / $316.23
| Facility | | $16.22 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $19.05 / $40.74
| Professional | | $13.18 | $19.05 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,951.21 / $3,715.35
| Facility | | $1,047.13 | $2,951.21 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $42.66
| Professional | | $25.70 | $36.31 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.49 / $30.20
| Facility | | $10.96 | $13.49 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.30 / $27.54
| Professional | | $10.23 | $12.30 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $38.90
| Professional | | $14.79 | $21.38 | $38.90 |