- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,344.23 / $5,623.41
| Facility | | $281.84 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $323.59 / $1,174.90
| Professional | | $158.49 | $323.59 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $1,513.56
| Professional | | $144.54 | $154.88 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,862.09 / $5,128.61
| Facility | | $676.08 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $436.52 / $977.24
| Professional | | $144.54 | $436.52 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $616.60 / $933.25
| Professional | | $154.88 | $616.60 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Facility | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $467.74 / $1,230.27
| Professional | | $173.78 | $467.74 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $741.31 / $1,995.26
| Facility | | $173.78 | $741.31 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,023.29 / $5,128.61
| Professional | | $660.69 | $1,023.29 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,258.93 / $2,884.03
| Facility | | $1,071.52 | $1,258.93 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $630.96 / $1,202.26
| Professional | | $177.83 | $630.96 | $1,202.26 |