- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $3,235.94 / $8,317.64
| Facility | | $123.03 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $112.20 / $251.19
| Professional | | $97.72 | $112.20 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $199.53
| Professional | | $104.71 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $660.69 / $933.25
| Professional | | $120.23 | $660.69 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $275.42
| Professional | | $100.00 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $309.03
| Professional | | $100.00 | $120.23 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $169.82 / $251.19
| Professional | | $138.04 | $169.82 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $223.87
| Facility | | $102.33 | $147.91 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $3,311.31
| Facility | | $97.72 | $144.54 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $3,311.31
| Professional | | $97.72 | $144.54 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,905.46 / $3,890.45
| Facility | | $1,047.13 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $208.93
| Professional | | $87.10 | $134.90 | $208.93 |