- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $436.52 / $7,244.36
| Facility | | $213.80 | $436.52 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $549.54
| Professional | | $151.36 | $281.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $758.58
| Professional | | $199.53 | $331.13 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,288.25
| Facility | | $524.81 | $524.81 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $575.44
| Professional | | $177.83 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $724.44
| Professional | | $467.74 | $467.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $295.12 / $501.19
| Facility | | $158.49 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $691.83
| Professional | | $446.68 | $575.44 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $3,548.13 / $6,760.83
| Facility | | $1,258.93 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $501.19
| Professional | | $144.54 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $28,840.32
| Facility | | $4,168.69 | $4,168.69 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,570.40
| Professional | | $2,137.96 | $2,137.96 | $2,570.40 |