- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $4,265.80 / $12,589.25
| Facility | | $446.68 | $4,265.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $199.53 / $446.68
| Professional | | $93.33 | $199.53 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $389.05
| Professional | | $109.65 | $194.98 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $302.00 / $630.96
| Professional | | $138.04 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $512.86
| Facility | | $102.33 | $199.53 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $1,548.82
| Professional | | $229.09 | $446.68 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $389.05 / $588.84
| Professional | | $213.80 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $346.74 / $512.86
| Professional | | $186.21 | $346.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $302.00 / $575.44
| Professional | | $5.01 | $302.00 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $6,760.83
| Facility | | $1,122.02 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $478.63
| Professional | | $128.82 | $245.47 | $478.63 |