- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,949.84 / $7,762.47
| Facility | | $478.63 | $1,949.84 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $1,230.27
| Professional | | $346.74 | $537.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $338.84 / $371.54
| Professional | | $323.59 | $338.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,511.89 / $8,128.31
| Facility | | $2,089.30 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $616.60 / $1,047.13
| Professional | | $446.68 | $616.60 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $588.84 / $954.99
| Professional | | $389.05 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $776.25 / $1,862.09
| Professional | | $457.09 | $776.25 | $1,862.09 |
- 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
- $467.74 / $478.63 / $707.95
| Professional | | $467.74 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $588.84
| Professional | | $32.36 | $33.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,388.44 / $5,754.40
| Facility | | $1,380.38 | $3,388.44 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $549.54 / $1,023.29
| Professional | | $338.84 | $549.54 | $1,023.29 |