- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,754.23 / $8,317.64
| Facility | | $257.04 | $2,754.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $524.81 / $1,737.80
| Professional | | $208.93 | $524.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $812.83 / $1,698.24
| Professional | | $223.87 | $812.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $257.04 / $933.25
| Professional | | $199.53 | $257.04 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $537.03 / $1,905.46
| Professional | | $239.88 | $537.03 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,258.93 / $1,548.82
| Professional | | $1,047.13 | $1,258.93 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,778.28 / $2,630.27
| Professional | | $363.08 | $1,778.28 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $812.83 / $2,137.96
| Facility | | $239.88 | $812.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Professional | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $316.23 / $1,479.11
| Facility | | $213.80 | $316.23 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,412.54 / $3,090.30
| Professional | | $891.25 | $1,412.54 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,023.29 / $2,344.23
| Facility | | $218.78 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $660.69 / $2,041.74
| Professional | | $208.93 | $660.69 | $2,041.74 |