- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $2,511.89 / $8,128.31
| Facility | | $229.09 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $234.42 / $549.54
| Professional | | $97.72 | $234.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $338.84
| Professional | | $181.97 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $1,905.46 / $11,220.18
| Facility | | $138.04 | $1,905.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $229.09 / $407.38
| Professional | | $107.15 | $229.09 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $72.44 / $323.59
| Facility | | $69.18 | $72.44 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $234.42 / $549.54
| Professional | | $104.71 | $234.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,041.74 / $3,388.44
| Facility | | $1,412.54 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $288.40 / $371.54
| Professional | | $213.80 | $288.40 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,445.44 / $3,630.78
| Facility | | $186.21 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $223.87 / $537.03
| Professional | | $97.72 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $263.03 / $407.38
| Professional | | $81.28 | $263.03 | $407.38 |