- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,715.35 / $9,332.54
| Facility | | $741.31 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $446.68
| Professional | | $112.20 | $223.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,041.74 / $11,220.18
| Facility | | $758.58 | $2,041.74 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $281.84
| Professional | | $117.49 | $213.80 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $794.33 / $933.25
| Facility | | $204.17 | $794.33 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $457.09
| Professional | | $120.23 | $229.09 | $457.09 |
- 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
- $186.21 / $194.98 / $251.19
| Professional | | $186.21 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $316.23
| Professional | | $32.36 | $33.11 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,311.31 / $6,918.31
| Facility | | $1,000.00 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $436.52
| Professional | | $109.65 | $213.80 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $204.17 / $275.42
| Professional | | $91.20 | $204.17 | $275.42 |