- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $2,137.96 / $6,918.31
| Facility | | $229.09 | $2,137.96 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $295.12 / $524.81
| Professional | | $138.04 | $295.12 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $257.04 / $426.58
| Professional | | $138.04 | $257.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $2,238.72 / $3,548.13
| Professional | | $151.36 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $512.86
| Professional | | $147.91 | $269.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $354.81 / $954.99
| Professional | | $117.49 | $354.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $660.69
| Professional | | $426.58 | $549.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $295.12 / $562.34
| Facility | | $151.36 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $4,073.80
| Facility | | $125.89 | $190.55 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $4,073.80
| Professional | | $263.03 | $416.87 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,162.28 / $5,754.40
| Facility | | $1,737.80 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $512.86
| Professional | | $123.03 | $257.04 | $512.86 |