- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,548.13 / $10,471.29
| Facility | | $323.59 | $3,548.13 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $354.81 / $870.96
| Professional | | $138.04 | $354.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $162.18 / $275.42
| Professional | | $125.89 | $162.18 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,466.84 / $8,709.64
| Facility | | $3,388.44 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $380.19
| Professional | | $158.49 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $602.56
| Professional | | $302.00 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $3,019.95
| Facility | | $190.55 | $331.13 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $1,548.82
| Professional | | $234.42 | $389.05 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $575.44
| Professional | | $346.74 | $457.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $478.63
| Professional | | $354.81 | $457.09 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,691.53 / $6,760.83
| Facility | | $2,041.74 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $478.63
| Professional | | $194.98 | $331.13 | $478.63 |