- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $4,897.79 / $10,964.78
| Facility | | $281.84 | $4,897.79 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $537.03
| Professional | | $128.82 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $467.74
| Professional | | $173.78 | $173.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $3,630.78 / $12,302.69
| Facility | | $281.84 | $3,630.78 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $371.54
| Professional | | $131.83 | $213.80 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $562.34
| Facility | | $239.88 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $524.81
| Professional | | $147.91 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,388.44 / $7,585.78
| Facility | | $2,238.72 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $208.93 / $398.11
| Professional | | $100.00 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $134.90 / $346.74
| Professional | | $32.36 | $134.90 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,137.96 / $5,011.87
| Facility | | $537.03 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $204.17 / $426.58
| Professional | | $112.20 | $204.17 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $371.54
| Professional | | $128.82 | $199.53 | $371.54 |