- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,467.37 / $8,317.64
| Facility | | $741.31 | $3,467.37 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $181.97 / $436.52
| Professional | | $53.70 | $181.97 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $223.87
| Professional | | $45.71 | $75.86 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,995.26 / $11,220.18
| Facility | | $416.87 | $1,995.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $173.78 / $257.04
| Professional | | $53.70 | $173.78 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $707.95 / $758.58
| Facility | | $97.72 | $707.95 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $141.25 / $380.19
| Professional | | $53.70 | $141.25 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $5,128.61 / $10,471.29
| Facility | | $2,754.23 | $5,128.61 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $234.42
| Professional | | $120.23 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $165.96
| Professional | | $32.36 | $43.65 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $3,311.31 / $6,918.31
| Facility | | $1,047.13 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $158.49 / $354.81
| Professional | | $47.86 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $91.20 / $229.09
| Professional | | $43.65 | $91.20 | $229.09 |