- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $2,238.72 / $3,801.89
| Facility | | $169.82 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $323.59
| Professional | | $102.33 | $151.36 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $524.81 / $2,691.53
| Facility | | $56.23 | $524.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $194.98 / $1,071.52
| Professional | | $114.82 | $194.98 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $295.12
| Facility | | $128.82 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $363.08 / $363.08
| Professional | | $354.81 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $446.68 / $501.19
| Facility | | $177.83 | $446.68 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $436.52
| Professional | | $117.49 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $3,311.31
| Facility | | $97.72 | $151.36 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $323.59
| Professional | | $154.88 | $218.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,819.70 / $3,467.37
| Facility | | $229.09 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $398.11
| Professional | | $123.03 | $213.80 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $524.81 / $2,691.53
| Facility | | $56.23 | $524.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $194.98 / $1,071.52
| Professional | | $114.82 | $194.98 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,122.02 / $2,754.23
| Facility | | $229.09 | $1,122.02 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $416.87
| Professional | | $117.49 | $213.80 | $416.87 |