- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $436.52 / $8,709.64
| Facility | | $112.20 | $436.52 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $229.09
| Professional | | $107.15 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $281.84 / $346.74
| Professional | | $144.54 | $281.84 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $501.19 / $602.56
| Facility | | $194.98 | $501.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $316.23
| Professional | | $123.03 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $234.42
| Facility | | $107.15 | $138.04 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $309.03
| Professional | | $181.97 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $173.78
| Professional | | $158.49 | $158.49 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,511.89 / $6,309.57
| Facility | | $323.59 | $2,511.89 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $245.47
| Professional | | $102.33 | $141.25 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $691.83 / $691.83
| Facility | | $56.23 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $954.99
| Professional | | $794.33 | $794.33 | $954.99 |