- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $3,311.31 / $8,912.51
| Facility | | $645.65 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,000.00 / $1,905.46
| Professional | | $234.42 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $6,760.83 / $13,803.84
| Facility | | $1,122.02 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $954.99 / $1,621.81
| Professional | | $251.19 | $954.99 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $407.38
| Facility | | $323.59 | $323.59 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $812.83 / $2,238.72
| Professional | | $239.88 | $812.83 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,884.03 / $6,760.83
| Facility | | $1,548.82 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $851.14 / $1,513.56
| Professional | | $794.33 | $851.14 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $691.83
| Professional | | $32.36 | $33.11 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,548.82 / $3,890.45
| Facility | | $295.12 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $954.99 / $2,454.71
| Professional | | $239.88 | $954.99 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $398.11 / $1,202.26
| Professional | | $181.97 | $398.11 | $1,202.26 |