- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $3,548.13 / $8,511.38
| Facility | | $309.03 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $144.54 / $380.19
| Professional | | $54.95 | $144.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $281.84
| Professional | | $190.55 | $190.55 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,162.28 / $6,165.95
| Facility | | $2,454.71 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $288.40
| Professional | | $64.57 | $125.89 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $426.58
| Professional | | $117.49 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $229.09 / $2,630.27
| Facility | | $52.48 | $229.09 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $309.03 / $1,148.15
| Professional | | $181.97 | $309.03 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $288.40 / $426.58
| Professional | | $123.03 | $288.40 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $338.84
| Professional | | $123.03 | $173.78 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $5,248.07
| Facility | | $912.01 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $169.82 / $363.08
| Professional | | $74.13 | $169.82 | $363.08 |