- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,344.23 / $11,481.54
| Facility | | $616.60 | $2,344.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $660.69 / $1,148.15
| Professional | | $467.74 | $660.69 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,238.72 / $3,981.07
| Facility | | $707.95 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $630.96 / $1,023.29
| Professional | | $467.74 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $549.54
| Facility | | $467.74 | $467.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $21,379.62
| Facility | | $645.65 | $794.33 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $831.76 / $1,288.25
| Professional | | $512.86 | $831.76 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $812.83 / $1,258.93
| Professional | | $512.86 | $812.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $354.81
| Professional | | $32.36 | $33.11 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $288.40
| Facility | | $100.00 | $100.00 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $707.95 / $1,230.27
| Professional | | $446.68 | $707.95 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $851.14 / $2,951.21
| Facility | | $177.83 | $851.14 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $691.83 / $1,122.02
| Professional | | $436.52 | $691.83 | $1,122.02 |