- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,890.45 / $9,332.54
| Facility | | $741.31 | $3,890.45 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $354.81
| Professional | | $95.50 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $173.78
| Professional | | $83.18 | $91.20 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $4,168.69 / $12,302.69
| Facility | | $144.54 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $173.78 / $275.42
| Professional | | $91.20 | $173.78 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $100.00 / $323.59
| Facility | | $95.50 | $100.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $218.78 / $446.68
| Professional | | $102.33 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,248.07 / $10,471.29
| Facility | | $2,818.38 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $269.15
| Professional | | $117.49 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $74.13 / $234.42
| Professional | | $32.36 | $74.13 | $234.42 |
- 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
- $134.90 / $223.87 / $426.58
| Professional | | $134.90 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $128.82 / $173.78
| Professional | | $74.13 | $128.82 | $173.78 |