- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,445.44 / $7,943.28
| Facility | | $363.08 | $1,445.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $309.03 / $851.14
| Professional | | $165.96 | $309.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $288.40
| Professional | | $281.84 | $281.84 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,348.96 / $3,388.44
| Facility | | $630.96 | $1,348.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $416.87 / $724.44
| Professional | | $158.49 | $416.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $588.84 / $1,148.15
| Facility | | $371.54 | $588.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $1,230.27
| Professional | | $199.53 | $371.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $302.00
| Professional | | $245.47 | $263.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $977.24
| Facility | | $190.55 | $331.13 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,897.79 / $9,772.37
| Facility | | $1,412.54 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $288.40 / $724.44
| Professional | | $158.49 | $288.40 | $724.44 |