- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $707.95 / $5,495.41
| Facility | | $144.54 | $707.95 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $213.80 / $575.44
| Professional | | $91.20 | $213.80 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $323.59
| Professional | | $83.18 | $83.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $288.40 / $501.19
| Professional | | $120.23 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $870.96
| Facility | | $398.11 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $407.38
| Professional | | $102.33 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $549.54
| Professional | | $354.81 | $354.81 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $218.78 / $363.08
| Facility | | $93.33 | $218.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $323.59 / $457.09
| Professional | | $134.90 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,137.96 / $4,265.80
| Facility | | $691.83 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $181.97 / $331.13
| Professional | | $85.11 | $181.97 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $19,498.45
| Facility | | $2,754.23 | $2,754.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Professional | | $2,511.89 | $2,511.89 | $2,511.89 |