- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,862.09 / $8,128.31
| Facility | | $338.84 | $1,862.09 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $489.78 / $1,148.15
| Professional | | $173.78 | $489.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $208.93 / $616.60
| Professional | | $158.49 | $208.93 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,548.13 / $4,786.30
| Facility | | $1,778.28 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $467.74 / $741.31
| Professional | | $213.80 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,000.00 / $2,691.53
| Facility | | $302.00 | $1,000.00 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $416.87 / $1,000.00
| Professional | | $194.98 | $416.87 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $794.33 / $1,778.28
| Professional | | $239.88 | $794.33 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $229.09 / $724.44
| Professional | | $218.78 | $229.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $812.83
| Professional | | $32.36 | $33.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,388.44 / $6,606.93
| Facility | | $1,698.24 | $3,388.44 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $457.09 / $891.25
| Professional | | $181.97 | $457.09 | $891.25 |