- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,096.48 / $9,120.11
| Facility | | $229.09 | $1,096.48 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $602.56
| Professional | | $190.55 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $263.03 / $524.81
| Professional | | $91.20 | $263.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,230.27 / $2,290.87
| Facility | | $562.34 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $338.84
| Professional | | $112.20 | $208.93 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $426.58
| Facility | | $213.80 | $275.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $588.84
| Professional | | $169.82 | $295.12 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $213.80 / $302.00
| Professional | | $199.53 | $213.80 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $288.40 / $501.19
| Facility | | $186.21 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,090.30 / $6,606.93
| Facility | | $691.83 | $3,090.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $407.38
| Professional | | $169.82 | $251.19 | $407.38 |