- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,737.80 / $11,481.54
| Facility | | $218.78 | $1,737.80 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $575.44
| Professional | | $112.20 | $234.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,137.96 / $4,365.16
| Facility | | $1,698.24 | $2,137.96 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $602.56
| Professional | | $190.55 | $363.08 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $288.40 / $691.83
| Professional | | $144.54 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $724.44
| Facility | | $173.78 | $309.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $588.84
| Professional | | $151.36 | $281.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $489.78
| Facility | | $295.12 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $354.81 / $354.81
| Facility | | $346.74 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $346.74 / $645.65
| Professional | | $173.78 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,238.72 / $4,365.16
| Facility | | $1,548.82 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $588.84
| Professional | | $190.55 | $363.08 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,630.27 / $4,677.35
| Facility | | $724.44 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $616.60
| Professional | | $151.36 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $208.93 / $354.81
| Professional | | $109.65 | $208.93 | $354.81 |