- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $346.74 / $5,495.41
| Facility | | $77.62 | $346.74 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $223.87 / $457.09
| Professional | | $77.62 | $223.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,737.80 / $1,949.84
| Facility | | $1,513.56 | $1,737.80 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $630.96
| Professional | | $107.15 | $223.87 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,445.44 / $2,570.40
| Facility | | $323.59 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $234.42 / $501.19
| Professional | | $91.20 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $208.93 / $416.87
| Facility | | $77.62 | $208.93 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $660.69
| Professional | | $131.83 | $131.83 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $426.58
| Professional | | $112.20 | $128.82 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,897.79 / $10,232.93
| Facility | | $954.99 | $4,897.79 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $181.97 / $363.08
| Professional | | $74.13 | $181.97 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $19,498.45
| Facility | | $8,128.31 | $8,128.31 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $2,290.87
| Professional | | $1,905.46 | $1,905.46 | $2,290.87 |