- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,412.54 / $8,317.64
| Facility | | $239.88 | $1,412.54 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $645.65 / $2,137.96
| Professional | | $239.88 | $645.65 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1,412.54 / $3,388.44
| Facility | | $1.00 | $1,412.54 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,445.44 / $4,168.69
| Professional | | $416.87 | $1,445.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,570.88 / $10,964.78
| Facility | | $2,884.03 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,096.48 / $4,570.88
| Professional | | $346.74 | $1,096.48 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,265.80 / $8,317.64
| Facility | | $3,467.37 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,698.24 / $4,466.84
| Professional | | $478.63 | $1,698.24 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $691.83 / $2,884.03
| Facility | | $302.00 | $691.83 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,691.53 / $8,912.51
| Professional | | $1,288.25 | $2,691.53 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $2,951.21 / $4,265.80
| Facility | | $602.56 | $2,951.21 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,584.89 / $2,951.21
| Professional | | $331.13 | $1,584.89 | $2,951.21 |