- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $3,090.30 / $8,912.51
| Facility | | $69.18 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $218.78 / $616.60
| Professional | | $112.20 | $218.78 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $263.03 / $1,778.28
| Facility | | $128.82 | $263.03 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $380.19 / $758.58
| Professional | | $302.00 | $380.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $371.54 / $812.83
| Facility | | $169.82 | $371.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $6,309.57
| Professional | | $218.78 | $478.63 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $316.23 / $575.44
| Professional | | $288.40 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $512.86
| Professional | | $281.84 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $512.86
| Professional | | $218.78 | $380.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $3,630.78
| Facility | | $1,995.26 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $338.84 / $676.08
| Professional | | $169.82 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $295.12 / $575.44
| Professional | | $245.47 | $295.12 | $575.44 |