- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $3,715.35 / $10,715.19
| Facility | | $478.63 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $275.42 / $2,630.27
| Professional | | $239.88 | $275.42 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,818.38 / $7,943.28
| Facility | | $1,000.00 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $457.09
| Professional | | $204.17 | $275.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $288.40
| Facility | | $245.47 | $245.47 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $21,379.62
| Facility | | $288.40 | $416.87 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $512.86
| Professional | | $229.09 | $338.84 | $512.86 |
- 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
- $223.87 / $338.84 / $512.86
| Professional | | $223.87 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $37.15
| Professional | | $32.36 | $33.11 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $1,995.26
| Facility | | $100.00 | $100.00 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $537.03
| Professional | | $234.42 | $288.40 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,691.53 / $5,248.07
| Facility | | $1,202.26 | $2,691.53 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $288.40 / $446.68
| Professional | | $186.21 | $288.40 | $446.68 |