- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,290.87 / $5,623.41
| Facility | | $190.55 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $239.88 / $575.44
| Professional | | $117.49 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $213.80 / $331.13
| Professional | | $173.78 | $213.80 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $338.84
| Professional | | $114.82 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $257.04 / $389.05
| Professional | | $125.89 | $257.04 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $218.78 / $416.87
| Professional | | $120.23 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $245.47 / $1,380.38
| Facility | | $117.49 | $245.47 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $380.19 / $1,862.09
| Professional | | $194.98 | $380.19 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,148.15 / $2,691.53
| Facility | | $954.99 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $380.19
| Professional | | $114.82 | $204.17 | $380.19 |