- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $1,819.70 / $4,570.88
| Facility | | $223.87 | $1,819.70 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $1,548.82
| Professional | | $147.91 | $363.08 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $134.90 / $1,023.29
| Professional | | $66.07 | $134.90 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $2,754.23 / $4,786.30
| Facility | | $851.14 | $2,754.23 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $1,202.26
| Professional | | $162.18 | $213.80 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $1,778.28
| Professional | | $173.78 | $281.84 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,445.44
| Professional | | $32.36 | $33.11 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $309.03 / $1,778.28
| Facility | | $162.18 | $309.03 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $331.13 / $2,089.30
| Professional | | $177.83 | $331.13 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,630.78 / $5,248.07
| Facility | | $758.58 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $1,949.84
| Professional | | $177.83 | $288.40 | $1,949.84 |