- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $457.09 / $4,897.79
| Facility | | $114.82 | $457.09 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $323.59
| Professional | | $97.72 | $134.90 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $218.78
| Facility | | $107.15 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $269.15
| Professional | | $218.78 | $218.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $380.19
| Professional | | $223.87 | $302.00 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $602.56
| Facility | | $117.49 | $173.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $234.42 / $954.99
| Professional | | $104.71 | $234.42 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $229.09 / $269.15
| Professional | | $223.87 | $229.09 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $239.88
| Professional | | $199.53 | $199.53 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $251.19
| Professional | | $128.82 | $208.93 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $194.98 / $309.03
| Professional | | $100.00 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $229.09 / $275.42
| Professional | | $190.55 | $229.09 | $275.42 |