- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $467.74 / $5,495.41
| Facility | | $181.97 | $467.74 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $158.49 / $309.03
| Professional | | $131.83 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $446.68
| Professional | | $162.18 | $295.12 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $398.11
| Facility | | $234.42 | $234.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $194.98 / $338.84
| Professional | | $144.54 | $194.98 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $346.74
| Professional | | $199.53 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $288.40
| Facility | | $141.25 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $380.19
| Professional | | $218.78 | $309.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $724.44 / $1,949.84
| Facility | | $194.98 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $302.00
| Professional | | $117.49 | $154.88 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $19,498.45
| Facility | | $1,995.26 | $1,995.26 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,348.96
| Professional | | $1,122.02 | $1,122.02 | $1,348.96 |