- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,174.90 / $1,995.26
| Facility | | $199.53 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $524.81 / $1,318.26
| Professional | | $199.53 | $524.81 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $2,137.96
| Facility | | $208.93 | $323.59 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $602.56 / $1,995.26
| Professional | | $169.82 | $602.56 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $562.34
| Facility | | $281.84 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $524.81 / $1,096.48
| Facility | | $199.53 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $645.65 / $1,174.90
| Professional | | $407.38 | $645.65 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,621.81 / $8,511.38
| Facility | | $147.91 | $1,621.81 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $1,148.15
| Professional | | $977.24 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $1,122.02
| Professional | | $676.08 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $2,137.96
| Facility | | $208.93 | $323.59 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $602.56 / $1,995.26
| Professional | | $169.82 | $602.56 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $338.84 / $676.08
| Facility | | $169.82 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $407.38 / $1,047.13
| Professional | | $169.82 | $407.38 | $1,047.13 |