- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $2,187.76 / $8,511.38
| Facility | | $144.54 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $151.36 / $524.81
| Professional | | $64.57 | $151.36 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- 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
- $79.43 / $131.83 / $218.78
| Professional | | $79.43 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $338.84
| Professional | | $144.54 | $218.78 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $165.96 / $1,230.27
| Facility | | $93.33 | $165.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $851.14
| Professional | | $134.90 | $245.47 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $346.74
| Professional | | $154.88 | $218.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $251.19
| Professional | | $154.88 | $218.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $4,466.84
| Facility | | $1,096.48 | $1,548.82 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $275.42
| Professional | | $95.50 | $158.49 | $275.42 |