- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $2,818.38 / $10,715.19
| Facility | | $223.87 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $457.09
| Professional | | $107.15 | $131.83 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,467.37 / $12,882.50
| Facility | | $954.99 | $3,467.37 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $109.65 / $177.83
| Professional | | $91.20 | $109.65 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $123.03 / $5,370.32
| Facility | | $112.20 | $123.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $141.25
| Professional | | $123.03 | $123.03 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $7,079.46
| Facility | | $199.53 | $398.11 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $295.12
| Professional | | $109.65 | $162.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $457.09 / $8,709.64
| Facility | | $199.53 | $457.09 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $295.12
| Professional | | $112.20 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $7,413.10
| Facility | | $100.00 | $100.00 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $131.83 / $251.19
| Professional | | $112.20 | $131.83 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $5,248.07 / $10,471.29
| Facility | | $933.25 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $213.80
| Professional | | $93.33 | $128.82 | $213.80 |