- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $3,801.89 / $12,589.25
| Facility | | $380.19 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $891.25
| Professional | | $144.54 | $186.21 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,677.35 / $9,120.11
| Facility | | $3,548.13 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $263.03 / $363.08
| Professional | | $151.36 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $389.05 / $549.54
| Professional | | $177.83 | $389.05 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $3,019.95
| Facility | | $173.78 | $295.12 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $354.81 / $1,380.38
| Professional | | $213.80 | $354.81 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $389.05 / $489.78
| Professional | | $346.74 | $389.05 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $416.87
| Professional | | $354.81 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $204.17 / $489.78
| Professional | | $5.01 | $204.17 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,630.27 / $6,760.83
| Facility | | $1,905.46 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $295.12 / $426.58
| Professional | | $194.98 | $295.12 | $426.58 |