- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $4,365.16 / $10,471.29
| Facility | | $912.01 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $295.12
| Professional | | $109.65 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $120.23 / $165.96
| Professional | | $109.65 | $120.23 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,570.88 / $12,302.69
| Facility | | $954.99 | $4,570.88 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $177.83
| Professional | | $91.20 | $123.03 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $21,877.62 / $47,863.01
| Facility | | $3,019.95 | $21,877.62 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $281.84
| Professional | | $104.71 | $181.97 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $83.18 / $162.18
| Professional | | $77.62 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $151.36
| Professional | | $32.36 | $33.11 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $10,715.19 / $18,620.87
| Facility | | $4,365.16 | $10,715.19 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $309.03
| Professional | | $109.65 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $125.89
| Professional | | $91.20 | $91.20 | $125.89 |