- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $2,570.40 / $10,715.19
| Facility | | $436.52 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $812.83
| Professional | | $275.42 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,778.28 / $3,548.13
| Facility | | $707.95 | $1,778.28 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $562.34
| Professional | | $245.47 | $346.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $309.03 / $346.74
| Facility | | $269.15 | $309.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $338.84
| Professional | | $295.12 | $295.12 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $457.09 / $501.19
| Facility | | $363.08 | $457.09 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $812.83
| Professional | | $288.40 | $436.52 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $457.09 / $1,318.26
| Facility | | $363.08 | $457.09 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $741.31
| Professional | | $288.40 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $181.97
| Professional | | $32.36 | $33.11 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $331.13
| Facility | | $100.00 | $100.00 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $741.31
| Professional | | $263.03 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $891.25 / $2,818.38
| Facility | | $199.53 | $891.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $630.96
| Professional | | $257.04 | $380.19 | $630.96 |