- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $2,630.27 / $8,317.64
| Facility | | $141.25 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $323.59
| Professional | | $120.23 | $141.25 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $223.87
| Professional | | $117.49 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $2,238.72 / $3,548.13
| Professional | | $134.90 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $288.40
| Professional | | $123.03 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $331.13
| Professional | | $107.15 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $229.09 / $288.40
| Professional | | $181.97 | $229.09 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $263.03
| Facility | | $120.23 | $177.83 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $2,951.21
| Facility | | $120.23 | $173.78 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $2,951.21
| Professional | | $120.23 | $177.83 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,949.84 / $3,890.45
| Facility | | $1,071.52 | $1,949.84 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $173.78 / $269.15
| Professional | | $109.65 | $173.78 | $269.15 |