- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,995.26 / $7,079.46
| Facility | | $186.21 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $676.08 / $1,047.13
| Professional | | $162.18 | $676.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $467.74 / $1,148.15
| Professional | | $169.82 | $467.74 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $2,511.89
| Professional | | $181.97 | $323.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $501.19 / $1,318.26
| Professional | | $177.83 | $501.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $891.25 / $2,398.83
| Professional | | $141.25 | $891.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,258.93 / $1,905.46
| Professional | | $1,000.00 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $676.08 / $1,380.38
| Facility | | $169.82 | $676.08 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $234.42 / $8,709.64
| Facility | | $154.88 | $234.42 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $8,709.64
| Professional | | $724.44 | $1,023.29 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,165.95 / $12,882.50
| Facility | | $3,630.78 | $6,165.95 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $489.78 / $1,348.96
| Professional | | $154.88 | $489.78 | $1,348.96 |