- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,570.40 / $6,760.83
| Facility | | $190.55 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $288.40 / $676.08
| Professional | | $134.90 | $288.40 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $446.68 / $575.44
| Professional | | $147.91 | $446.68 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $691.83
| Professional | | $162.18 | $295.12 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,445.44 / $2,344.23
| Facility | | $323.59 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $575.44
| Professional | | $147.91 | $281.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Professional | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $263.03 / $467.74
| Facility | | $134.90 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $758.58
| Professional | | $158.49 | $158.49 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $489.78
| Professional | | $194.98 | $245.47 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,897.79 / $10,232.93
| Facility | | $954.99 | $4,897.79 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $426.58
| Professional | | $120.23 | $229.09 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $19,498.45
| Facility | | $8,128.31 | $8,128.31 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,630.27
| Professional | | $2,238.72 | $2,238.72 | $2,630.27 |