- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $5,495.41 / $22,387.21
| Facility | | $776.25 | $5,495.41 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $645.65 / $1,778.28
| Professional | | $213.80 | $645.65 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $2,344.23 / $4,365.16
| Facility | | $912.01 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,479.11 / $1,949.84
| Professional | | $354.81 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,000.00 / $1,905.46
| Professional | | $257.04 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,511.89 / $2,511.89
| Professional | | $1,905.46 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,071.52 / $2,511.89
| Facility | | $251.19 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,096.48 / $2,344.23
| Professional | | $288.40 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $407.38 / $645.65
| Professional | | $32.36 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $2,137.96
| Professional | | $380.19 | $512.86 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $977.24 / $2,089.30
| Professional | | $389.05 | $977.24 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $588.84 / $1,995.26
| Professional | | $239.88 | $588.84 | $1,995.26 |