- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $3,801.89 / $8,511.38
| Facility | | $239.88 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $263.03 / $575.44
| Professional | | $107.15 | $263.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $338.84
| Professional | | $204.17 | $239.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,089.30 / $4,073.80
| Facility | | $1,621.81 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $199.53 / $346.74
| Professional | | $125.89 | $199.53 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $316.23 / $549.54
| Professional | | $128.82 | $316.23 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $251.19 / $1,230.27
| Facility | | $131.83 | $251.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $1,380.38
| Professional | | $190.55 | $281.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $436.52
| Professional | | $218.78 | $309.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $407.38
| Professional | | $239.88 | $239.88 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $190.55 / $501.19
| Professional | | $3.02 | $190.55 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,047.13 / $3,801.89
| Facility | | $251.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $223.87 / $380.19
| Professional | | $134.90 | $223.87 | $380.19 |