- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,801.89 / $8,511.38
| Facility | | $346.74 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $549.54 / $1,905.46
| Professional | | $169.82 | $549.54 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $363.08
| Professional | | $134.90 | $134.90 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,165.95 / $12,022.64
| Facility | | $4,677.35 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $562.34
| Professional | | $199.53 | $323.59 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $575.44 / $912.01
| Professional | | $380.19 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $446.68 / $4,265.80
| Facility | | $199.53 | $446.68 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $831.76 / $3,090.30
| Professional | | $467.74 | $831.76 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $691.83 / $1,230.27
| Professional | | $380.19 | $691.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $912.01
| Professional | | $338.84 | $537.03 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,897.79 / $6,760.83
| Facility | | $3,630.78 | $4,897.79 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $691.83 / $1,202.26
| Professional | | $407.38 | $691.83 | $1,202.26 |