- 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
- $60.26 / $158.49 / $912.01
| Professional | | $60.26 | $158.49 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $933.25 / $1,819.70
| Facility | | $724.44 | $933.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $141.25 / $309.03
| Professional | | $74.13 | $141.25 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $380.19
| Professional | | $128.82 | $186.21 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $186.21 / $1,096.48
| Facility | | $74.13 | $186.21 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $1,230.27
| Professional | | $154.88 | $251.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $302.00 / $389.05
| Professional | | $138.04 | $302.00 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $436.52
| Professional | | $125.89 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $151.36 / $380.19
| Professional | | $64.57 | $151.36 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $5,248.07
| Facility | | $1,096.48 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $162.18 / $346.74
| Professional | | $77.62 | $162.18 | $346.74 |