- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,187.76 / $5,128.61
| Facility | | $588.84 | $2,187.76 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $245.47 / $1,148.15
| Professional | | $112.20 | $245.47 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $346.74
| Facility | | $165.96 | $194.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $354.81 / $371.54
| Professional | | $204.17 | $354.81 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $1,737.80
| Professional | | $309.03 | $489.78 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $436.52 / $1,412.54
| Facility | | $181.97 | $436.52 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $977.24 / $4,365.16
| Professional | | $223.87 | $977.24 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $1,288.25
| Professional | | $331.13 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $741.31
| Professional | | $229.09 | $229.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $707.95 / $1,122.02
| Professional | | $239.88 | $707.95 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $3,890.45
| Facility | | $1,995.26 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $489.78 / $1,348.96
| Professional | | $213.80 | $489.78 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $407.38 / $1,348.96
| Professional | | $338.84 | $407.38 | $1,348.96 |