- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $7,943.28 / $21,877.62
| Facility | | $6.76 | $7,943.28 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $18.62 / $38.90
| Professional | | $6.03 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $28.18
| Professional | | $24.55 | $24.55 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $331.13
| Facility | | $120.23 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $26.92 / $51.29
| Professional | | $10.00 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $30.20 / $75.86
| Facility | | $11.48 | $30.20 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $21.38 / $60.26
| Professional | | $11.48 | $21.38 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $47.86
| Facility | | $26.30 | $43.65 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $33.11
| Facility | | $30.90 | $30.90 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $33.11 / $58.88
| Professional | | $10.00 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $331.13
| Facility | | $112.20 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $23.99 / $50.12
| Professional | | $10.00 | $23.99 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $912.01
| Facility | | $158.49 | $229.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $23.44 / $52.48
| Professional | | $10.00 | $23.44 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $53.70
| Professional | | $28.18 | $33.11 | $53.70 |