- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,122.02 / $5,495.41
| Facility | | $208.93 | $1,122.02 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $616.60
| Professional | | $112.20 | $234.42 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $263.03 / $489.78
| Professional | | $112.20 | $263.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $1,513.56 / $2,511.89
| Professional | | $123.03 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $281.84 / $851.14
| Professional | | $120.23 | $281.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $363.08 / $977.24
| Professional | | $91.20 | $363.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $302.00 / $724.44
| Facility | | $120.23 | $302.00 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $3,311.31
| Facility | | $104.71 | $151.36 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $630.96 / $3,311.31
| Professional | | $316.23 | $630.96 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,905.46 / $3,890.45
| Facility | | $1,047.13 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $251.19 / $891.25
| Professional | | $102.33 | $251.19 | $891.25 |