- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,818.38 / $8,128.31
| Facility | | $213.80 | $2,818.38 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $426.58
| Professional | | $151.36 | $194.98 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $288.40
| Professional | | $89.13 | $173.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $4,265.80 / $12,302.69
| Facility | | $309.03 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $213.80
| Professional | | $158.49 | $190.55 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $398.11
| Facility | | $263.03 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $371.54
| Professional | | $147.91 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $8,912.51
| Facility | | $2,454.71 | $3,467.37 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $144.54 / $204.17
| Professional | | $134.90 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $234.42
| Professional | | $32.36 | $33.11 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,290.87 / $5,011.87
| Facility | | $537.03 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $371.54
| Professional | | $141.25 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $199.53
| Professional | | $120.23 | $138.04 | $199.53 |