- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $2,818.38 / $8,128.31
| Facility | | $147.91 | $2,818.38 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $169.82 / $363.08
| Professional | | $87.10 | $169.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $295.12
| Professional | | $89.13 | $158.49 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $4,168.69 / $12,302.69
| Facility | | $144.54 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $186.21
| Professional | | $89.13 | $138.04 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $151.36
| Facility | | $125.89 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $309.03
| Professional | | $89.13 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,090.30 / $6,309.57
| Facility | | $2,089.30 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $120.23 / $165.96
| Professional | | $114.82 | $120.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $194.98
| Professional | | $32.36 | $33.11 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,445.44 / $3,630.78
| Facility | | $331.13 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $302.00
| Professional | | $83.18 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $173.78
| Professional | | $69.18 | $128.82 | $173.78 |