- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $3,235.94 / $7,585.78
| Facility | | $316.23 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $354.81 / $660.69
| Professional | | $204.17 | $354.81 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $588.84
| Professional | | $208.93 | $354.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $3,467.37 / $5,495.41
| Professional | | $213.80 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $602.56
| Professional | | $208.93 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $407.38 / $1,071.52
| Professional | | $169.82 | $407.38 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $870.96
| Professional | | $389.05 | $489.78 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $616.60
| Facility | | $208.93 | $380.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $10,000.00
| Facility | | $190.55 | $269.15 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $10,000.00
| Professional | | $288.40 | $446.68 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $8,317.64 / $17,378.01
| Facility | | $5,495.41 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $323.59 / $575.44
| Professional | | $186.21 | $323.59 | $575.44 |