- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $5,011.87 / $11,481.54
| Facility | | $691.83 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $302.00 / $1,202.26
| Professional | | $199.53 | $302.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $478.63
| Professional | | $194.98 | $194.98 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,162.28 / $6,165.95
| Facility | | $2,398.83 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $616.60
| Professional | | $245.47 | $389.05 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $676.08 / $912.01
| Professional | | $316.23 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $6,309.57
| Facility | | $302.00 | $524.81 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $2,398.83
| Professional | | $407.38 | $660.69 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $691.83 / $954.99
| Professional | | $489.78 | $691.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $691.83
| Professional | | $478.63 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $575.44 / $891.25
| Professional | | $3.02 | $575.44 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,495.41 / $6,760.83
| Facility | | $3,630.78 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $758.58
| Professional | | $288.40 | $467.74 | $758.58 |