- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $4,073.80 / $9,549.93
| Facility | | $346.74 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $275.42 / $575.44
| Professional | | $131.83 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $223.87 / $354.81
| Professional | | $89.13 | $223.87 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $2,884.03 / $11,220.18
| Facility | | $354.81 | $2,884.03 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $239.88 / $354.81
| Professional | | $138.04 | $239.88 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,000.00 / $1,548.82
| Facility | | $234.42 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $263.03 / $512.86
| Professional | | $141.25 | $263.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $8,912.51 / $16,982.44
| Facility | | $4,365.16 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $234.42 / $398.11
| Professional | | $114.82 | $234.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $107.15 / $389.05
| Professional | | $32.36 | $107.15 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $5,248.07 / $9,549.93
| Facility | | $1,621.81 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $426.58
| Professional | | $109.65 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $354.81
| Professional | | $107.15 | $239.88 | $354.81 |