- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,041.74 / $7,762.47
| Facility | | $257.04 | $2,041.74 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $263.03 / $501.19
| Professional | | $125.89 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $117.49 / $281.84
| Professional | | $54.95 | $117.49 | $281.84 |
- 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
- $131.83 / $251.19 / $346.74
| Professional | | $131.83 | $251.19 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $794.33 / $933.25
| Facility | | $223.87 | $794.33 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $245.47 / $489.78
| Professional | | $131.83 | $245.47 | $489.78 |
- 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
- $208.93 / $223.87 / $323.59
| Professional | | $208.93 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $346.74
| Professional | | $32.36 | $33.11 | $346.74 |
- 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
- $125.89 / $251.19 / $512.86
| Professional | | $125.89 | $251.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $208.93 / $309.03
| Professional | | $100.00 | $208.93 | $309.03 |