- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $3,630.78 / $9,549.93
| Facility | | $239.88 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $398.11
| Professional | | $194.98 | $234.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,025.60 / $8,128.31
| Facility | | $3,890.45 | $6,025.60 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $407.38
| Professional | | $199.53 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $239.88 / $426.58
| Professional | | $213.80 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $616.60
| Facility | | $354.81 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $489.78
| Professional | | $204.17 | $269.15 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $380.19
| Professional | | $181.97 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $309.03 / $416.87
| Professional | | $288.40 | $309.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $446.68
| Facility | | $208.93 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $457.09
| Professional | | $263.03 | $263.03 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $269.15 / $1,023.29
| Facility | | $208.93 | $269.15 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $269.15 / $1,023.29
| Professional | | $208.93 | $269.15 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $3,162.28 / $5,754.40
| Facility | | $436.52 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $416.87
| Professional | | $173.78 | $251.19 | $416.87 |