- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $3,311.31 / $9,120.11
| Facility | | $204.17 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $371.54
| Professional | | $131.83 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $213.80
| Professional | | $117.49 | $158.49 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $4,168.69 / $12,302.69
| Facility | | $204.17 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $194.98 / $257.04
| Professional | | $141.25 | $194.98 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $154.88 / $323.59
| Facility | | $151.36 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $371.54
| Professional | | $131.83 | $213.80 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,388.44 / $7,585.78
| Facility | | $2,454.71 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $177.83 / $263.03
| Professional | | $165.96 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $181.97 / $338.84
| Professional | | $32.36 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,290.87 / $5,011.87
| Facility | | $575.44 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $346.74
| Professional | | $120.23 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $245.47
| Professional | | $120.23 | $181.97 | $245.47 |