- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,288.25 / $8,709.64
| Facility | | $281.84 | $1,288.25 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $199.53 / $380.19
| Professional | | $173.78 | $199.53 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $562.34
| Professional | | $199.53 | $269.15 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $275.42 / $457.09
| Professional | | $194.98 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $446.68
| Professional | | $363.08 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $416.87
| Facility | | $190.55 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $389.05
| Professional | | $251.19 | $316.23 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $794.33 / $1,995.26
| Facility | | $218.78 | $794.33 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $229.09 / $389.05
| Professional | | $165.96 | $229.09 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $45,708.82
| Facility | | $2,511.89 | $2,511.89 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,659.59
| Professional | | $1,445.44 | $1,445.44 | $1,659.59 |