- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $5,495.41
| Facility | | $331.13 | $426.58 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $741.31
| Professional | | $263.03 | $338.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $933.25
| Professional | | $302.00 | $436.52 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $602.56
| Facility | | $234.42 | $234.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $676.08
| Professional | | $281.84 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $724.44
| Professional | | $457.09 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $575.44
| Facility | | $281.84 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $489.78 / $660.69
| Professional | | $416.87 | $489.78 | $660.69 |
- 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
- $239.88 / $316.23 / $602.56
| Professional | | $239.88 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,819.70 / $1,819.70
| Facility | | $56.23 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | 54 | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,754.23
| Professional | | $2,290.87 | $2,290.87 | $2,754.23 |