- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $3,235.94 / $8,912.51
| Facility | | $223.87 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $467.74
| Professional | | $141.25 | $251.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $316.23 / $524.81
| Professional | | $186.21 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $1,995.26
| Professional | | $162.18 | $190.55 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $524.81
| Facility | | $239.88 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $489.78
| Professional | | $144.54 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $724.44
| Professional | | $331.13 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $346.74
| Professional | | $190.55 | $234.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $275.42 / $501.19
| Facility | | $147.91 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $398.11
| Professional | | $63.10 | $63.10 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $794.33
| Facility | | $123.03 | $186.21 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $316.23 / $1,288.25
| Professional | | $186.21 | $316.23 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,698.24 / $3,548.13
| Facility | | $346.74 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $446.68
| Professional | | $125.89 | $229.09 | $446.68 |