- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $5,128.61 / $8,912.51
| Facility | | $257.04 | $5,128.61 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $257.04 / $1,230.27
| Professional | | $208.93 | $257.04 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $8,709.64 / $12,022.64
| Facility | | $6,918.31 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $263.03 / $363.08
| Professional | | $194.98 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $4,897.79 / $6,918.31
| Professional | | $204.17 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $446.68
| Professional | | $194.98 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $208.93 / $257.04
| Professional | | $173.78 | $208.93 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $489.78
| Professional | | $316.23 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $436.52
| Facility | | $208.93 | $309.03 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $10,000.00
| Facility | | $194.98 | $288.40 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $10,000.00
| Professional | | $194.98 | $288.40 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $8,317.64 / $17,378.01
| Facility | | $5,495.41 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $457.09
| Professional | | $186.21 | $302.00 | $457.09 |