- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,090.30 / $5,888.44
| Facility | | $812.83 | $3,090.30 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $1,202.26
| Professional | | $371.54 | $524.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $363.08 / $389.05
| Professional | | $354.81 | $363.08 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,786.30 / $9,332.54
| Facility | | $4,073.80 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $691.83 / $870.96
| Professional | | $501.19 | $691.83 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $616.60 / $912.01
| Professional | | $398.11 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $741.31 / $1,949.84
| Professional | | $446.68 | $741.31 | $1,949.84 |
- 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
- $501.19 / $537.03 / $588.84
| Professional | | $501.19 | $537.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $446.68
| Professional | | $32.36 | $33.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,467.37 / $7,585.78
| Facility | | $2,089.30 | $3,467.37 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $954.99
| Professional | | $380.19 | $537.03 | $954.99 |