- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,019.95 / $10,715.19
| Facility | | $323.59 | $3,019.95 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $758.58
| Professional | | $218.78 | $309.03 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,511.89 / $5,888.44
| Facility | | $954.99 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $436.52
| Professional | | $199.53 | $275.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $239.88 / $831.76
| Facility | | $213.80 | $239.88 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $269.15
| Professional | | $234.42 | $234.42 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $512.86 / $1,047.13
| Facility | | $263.03 | $512.86 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $602.56
| Professional | | $234.42 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $2,454.71
| Facility | | $389.05 | $616.60 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $562.34
| Professional | | $229.09 | $338.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $134.90
| Professional | | $32.36 | $33.11 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $1,905.46
| Facility | | $100.00 | $100.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $575.44
| Professional | | $204.17 | $309.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,290.87 / $5,248.07
| Facility | | $724.44 | $2,290.87 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $467.74
| Professional | | $199.53 | $295.12 | $467.74 |