- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $3,890.45 / $8,317.64
| Facility | | $234.42 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $1,412.54 / $6,606.93
| Professional | | $52.48 | $1,412.54 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $104.71
| Professional | | $53.70 | $74.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $61.66 / $64.57
| Professional | | $54.95 | $61.66 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26,302.68 / $26,302.68 / $26,302.68
| Professional | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,762.47 / $9,120.11
| Professional | | $6,025.60 | $7,762.47 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $2,238.72 / $8,912.51
| Facility | | $52.48 | $2,238.72 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $1,737.80
| Professional | | $123.03 | $123.03 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $891.25 / $10,000.00
| Facility | | $57.54 | $891.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,715.35 / $10,000.00
| Professional | | $1,174.90 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,398.83
| Facility | | $204.17 | $1,047.13 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $1,230.27 / $3,467.37
| Professional | | $51.29 | $1,230.27 | $3,467.37 |