- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $660.69 / $3,235.94
| Facility | | $190.55 | $660.69 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $691.83 / $1,174.90
| Professional | | $128.82 | $691.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $467.74 / $1,995.26
| Professional | | $147.91 | $467.74 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $933.25 / $1,288.25
| Professional | | $131.83 | $933.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $645.65 / $1,778.28
| Facility | | $158.49 | $645.65 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,348.96 / $5,011.87
| Professional | | $537.03 | $1,348.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,412.54 / $2,041.74
| Professional | | $281.84 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,479.11 / $2,570.40
| Professional | | $269.15 | $1,479.11 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $707.95 / $1,621.81
| Professional | | $120.23 | $707.95 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $758.58 / $933.25
| Facility | | $416.87 | $758.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $467.74 / $1,548.82
| Professional | | $125.89 | $467.74 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $309.03 / $1,584.89
| Professional | | $257.04 | $309.03 | $1,584.89 |