- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $660.69 / $1,288.25
| Facility | | $123.03 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $354.81 / $851.14
| Professional | | $123.03 | $354.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,380.38
| Facility | | $323.59 | $478.63 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $407.38 / $1,479.11
| Professional | | $177.83 | $407.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $870.96 / $1,258.93
| Facility | | $691.83 | $870.96 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $346.74 / $851.14
| Facility | | $151.36 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $1,148.15
| Professional | | $239.88 | $426.58 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $741.31
| Professional | | $630.96 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $741.31
| Professional | | $436.52 | $436.52 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,380.38
| Facility | | $323.59 | $478.63 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $407.38 / $1,479.11
| Professional | | $177.83 | $407.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $263.03 / $436.52
| Facility | | $107.15 | $263.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $316.23 / $831.76
| Professional | | $107.15 | $316.23 | $831.76 |