- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $1,949.84 / $8,317.64
| Facility | | $138.04 | $1,949.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $239.88
| Professional | | $100.00 | $144.54 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $275.42
| Professional | | $123.03 | $181.97 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $2,818.38 / $4,365.16
| Professional | | $128.82 | $2,818.38 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $288.40
| Professional | | $107.15 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $436.52
| Professional | | $102.33 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $380.19
| Professional | | $147.91 | $186.21 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $234.42
| Facility | | $104.71 | $154.88 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $8,709.64
| Facility | | $91.20 | $138.04 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $8,709.64
| Professional | | $112.20 | $186.21 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,165.95 / $12,882.50
| Facility | | $3,630.78 | $6,165.95 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $245.47
| Professional | | $91.20 | $147.91 | $245.47 |