- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $2,290.87 / $6,760.83
| Facility | | $123.03 | $2,290.87 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $234.42 / $588.84
| Professional | | $72.44 | $234.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $269.15 / $812.83
| Professional | | $77.62 | $269.15 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $363.08 / $562.34
| Professional | | $70.79 | $363.08 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $316.23 / $2,951.21
| Facility | | $89.13 | $316.23 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $446.68 / $2,041.74
| Professional | | $199.53 | $446.68 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $346.74 / $676.08
| Professional | | $173.78 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $436.52 / $776.25
| Professional | | $114.82 | $436.52 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $489.78 / $794.33
| Professional | | $3.98 | $489.78 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,162.28 / $6,165.95
| Facility | | $1,548.82 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $218.78 / $562.34
| Professional | | $77.62 | $218.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $616.60
| Professional | | $147.91 | $177.83 | $616.60 |