- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,187.76 / $3,801.89
| Facility | | $257.04 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $245.47 / $616.60
| Professional | | $112.20 | $245.47 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,148.15 / $3,801.89
| Facility | | $56.23 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $281.84 / $812.83
| Professional | | $125.89 | $281.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $309.03
| Facility | | $131.83 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $302.00 / $676.08
| Professional | | $131.83 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $616.60
| Professional | | $144.54 | $275.42 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $3,311.31
| Facility | | $104.71 | $151.36 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $354.81 / $562.34
| Professional | | $275.42 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $7,079.46
| Facility | | $1,288.25 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $288.40 / $630.96
| Professional | | $123.03 | $288.40 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $3,890.45
| Facility | | $2,570.40 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,148.15 / $3,801.89
| Facility | | $56.23 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $281.84 / $812.83
| Professional | | $125.89 | $281.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,089.30 / $5,623.41
| Facility | | $794.33 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $295.12 / $645.65
| Professional | | $128.82 | $295.12 | $645.65 |