- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $7,943.28 / $14,454.40
| Facility | | $223.87 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $676.08
| Professional | | $112.20 | $138.04 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,019.95 / $5,888.44
| Facility | | $2,344.23 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $281.84
| Professional | | $114.82 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $436.52
| Professional | | $151.36 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $239.88 / $1,778.28
| Facility | | $138.04 | $239.88 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $3,019.95
| Professional | | $177.83 | $302.00 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $436.52
| Professional | | $288.40 | $346.74 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $331.13
| Professional | | $269.15 | $269.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $229.09 / $398.11
| Professional | | $3.98 | $229.09 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,548.82 / $5,248.07
| Facility | | $1,148.15 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $251.19 / $346.74
| Professional | | $165.96 | $251.19 | $346.74 |