- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $3,801.89 / $12,589.25
| Facility | | $199.53 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $263.03 / $575.44
| Professional | | $114.82 | $263.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $363.08
| Professional | | $213.80 | $251.19 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,089.30 / $4,073.80
| Facility | | $1,621.81 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $302.00
| Professional | | $123.03 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $426.58
| Professional | | $151.36 | $302.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $251.19 / $1,230.27
| Facility | | $125.89 | $251.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $295.12 / $1,202.26
| Professional | | $194.98 | $295.12 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $426.58
| Professional | | $251.19 | $338.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $354.81
| Professional | | $234.42 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $263.03 / $426.58
| Professional | | $3.02 | $263.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,047.13 / $3,801.89
| Facility | | $380.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $229.09 / $363.08
| Professional | | $144.54 | $229.09 | $363.08 |