- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,388.44 / $8,317.64
| Facility | | $323.59 | $3,388.44 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $891.25
| Professional | | $173.78 | $281.84 | $891.25 |
- 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
- $407.38 / $549.54 / $776.25
| Professional | | $407.38 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $407.38
| Professional | | $338.84 | $380.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $380.19 / $457.09
| Professional | | $309.03 | $380.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $275.42 / $457.09
| Facility | | $173.78 | $275.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $575.44 / $10,000.00
| Facility | | $257.04 | $575.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $575.44 / $10,000.00
| Professional | | $257.04 | $575.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,905.46 / $3,890.45
| Facility | | $977.24 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $302.00 / $602.56
| Professional | | $158.49 | $302.00 | $602.56 |