- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $3,090.30 / $7,762.47
| Facility | | $281.84 | $3,090.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $676.08
| Professional | | $177.83 | $234.42 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $10,000.00
| Facility | | $2,630.27 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $489.78
| Professional | | $151.36 | $194.98 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,258.93 / $4,073.80
| Facility | | $281.84 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $3,801.89 / $53,703.18
| Facility | | $338.84 | $3,801.89 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $912.01
| Professional | | $199.53 | $398.11 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $691.83
| Facility | | $208.93 | $275.42 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $371.54
| Professional | | $190.55 | $257.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $426.58
| Professional | | $165.96 | $263.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $50,118.72 / $75,857.76
| Facility | | $199.53 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $426.58
| Professional | | $234.42 | $302.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,981.07 / $9,120.11
| Facility | | $2,137.96 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $602.56
| Professional | | $190.55 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $645.65
| Facility | | $165.96 | $234.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $245.47 / $645.65
| Professional | | $165.96 | $245.47 | $645.65 |