- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $4,897.79 / $9,772.37
| Facility | | $380.19 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $275.42 / $575.44
| Professional | | $134.90 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $229.09 / $234.42
| Professional | | $190.55 | $229.09 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $3,890.45 / $8,317.64
| Facility | | $870.96 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $363.08
| Professional | | $134.90 | $186.21 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $426.58 / $1,862.09
| Facility | | $371.54 | $426.58 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $263.03 / $602.56
| Professional | | $147.91 | $263.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $302.00 / $323.59
| Professional | | $281.84 | $302.00 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $512.86
| Facility | | $144.54 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $10,000.00 / $16,595.87
| Facility | | $1,995.26 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $398.11
| Professional | | $120.23 | $229.09 | $398.11 |