- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $3,090.30 / $8,912.51
| Facility | | $457.09 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $218.78 / $407.38
| Professional | | $109.65 | $218.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $151.36
| Professional | | $141.25 | $141.25 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,348.96 / $11,220.18
| Facility | | $194.98 | $1,348.96 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $269.15
| Professional | | $109.65 | $204.17 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $724.44
| Facility | | $199.53 | $199.53 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $489.78
| Professional | | $131.83 | $239.88 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,467.37 / $8,912.51
| Facility | | $2,344.23 | $3,467.37 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $229.09 / $346.74
| Professional | | $169.82 | $229.09 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $89.13 / $331.13
| Professional | | $32.36 | $89.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $2,137.96 / $5,011.87
| Facility | | $436.52 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $229.09 / $446.68
| Professional | | $114.82 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $251.19
| Professional | | $89.13 | $190.55 | $251.19 |