- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,862.09 / $5,623.41
| Facility | | $239.88 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $257.04 / $537.03
| Professional | | $125.89 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,511.89 / $3,235.94
| Facility | | $1,202.26 | $2,511.89 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $489.78
| Professional | | $151.36 | $288.40 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,762.47 / $10,964.78
| Facility | | $6,309.57 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $489.78
| Professional | | $147.91 | $269.15 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $380.19 / $1,047.13
| Professional | | $173.78 | $380.19 | $1,047.13 |
- 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
- $154.88 / $162.18 / $363.08
| Professional | | $154.88 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,238.72 / $4,786.30
| Facility | | $1,513.56 | $2,238.72 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $275.42 / $512.86
| Professional | | $147.91 | $275.42 | $512.86 |