- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $954.99 / $2,187.76
| Facility | | $338.84 | $954.99 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $281.84 / $436.52
| Professional | | $234.42 | $281.84 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $281.84 / $562.34
| Professional | | $269.15 | $281.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,148.15 / $3,388.44
| Facility | | $302.00 | $1,148.15 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $354.81 / $575.44
| Professional | | $213.80 | $354.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $309.03
| Facility | | $234.42 | $234.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $331.13 / $467.74
| Professional | | $154.88 | $331.13 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $630.96 / $1,071.52
| Facility | | $302.00 | $630.96 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $371.54
| Professional | | $234.42 | $275.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $512.86 / $645.65
| Professional | | $269.15 | $512.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $275.42
| Facility | | $194.98 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $275.42 / $416.87
| Professional | | $194.98 | $275.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,801.89 / $4,365.16
| Facility | | $2,290.87 | $3,801.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $331.13 / $562.34
| Professional | | $213.80 | $331.13 | $562.34 |