- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,981.07 / $9,332.54
| Facility | | $812.83 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $363.08 / $758.58
| Professional | | $281.84 | $363.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $331.13 / $331.13
| Professional | | $281.84 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $6,309.57 / $12,302.69
| Facility | | $891.25 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $398.11
| Professional | | $263.03 | $346.74 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $10,000.00
| Facility | | $398.11 | $398.11 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $691.83
| Professional | | $302.00 | $426.58 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $23,442.29 / $34,673.69
| Facility | | $10,000.00 | $23,442.29 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $234.42 / $338.84
| Professional | | $218.78 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,311.31 / $7,079.46
| Facility | | $707.95 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $707.95
| Professional | | $269.15 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $354.81
| Professional | | $257.04 | $257.04 | $354.81 |