- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $933.25 / $6,760.83
| Facility | | $346.74 | $933.25 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $104.71 / $257.04
| Professional | | $51.29 | $104.71 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $138.04
| Professional | | $52.48 | $100.00 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,995.26 / $11,220.18
| Facility | | $213.80 | $1,995.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $138.04
| Professional | | $53.70 | $75.86 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $436.52
| Facility | | $102.33 | $213.80 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $95.50 / $181.97
| Professional | | $50.12 | $95.50 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,090.30 / $6,309.57
| Facility | | $2,041.74 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $141.25
| Professional | | $58.88 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $186.21
| Professional | | $32.36 | $72.44 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,445.44 / $3,890.45
| Facility | | $316.23 | $1,445.44 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $169.82
| Professional | | $46.77 | $83.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $97.72 / $138.04
| Professional | | $46.77 | $97.72 | $138.04 |