- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $691.83 / $8,511.38
| Facility | | $204.17 | $691.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $213.80 / $478.63
| Professional | | $97.72 | $213.80 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $251.19
| Professional | | $120.23 | $194.98 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $3,162.28
| Facility | | $1,258.93 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $177.83 / $239.88
| Professional | | $104.71 | $177.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $257.04 / $338.84
| Professional | | $194.98 | $257.04 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $229.09 / $954.99
| Facility | | $114.82 | $229.09 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 54 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $954.99
| Professional | | $144.54 | $245.47 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $338.84
| Professional | | $223.87 | $269.15 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $316.23
| Professional | | $239.88 | $281.84 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,348.96 / $1,348.96
| Facility | | $1,148.15 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,047.13 / $3,801.89
| Facility | | $251.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $213.80 / $295.12
| Professional | | $125.89 | $213.80 | $295.12 |