- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $3,090.30 / $6,760.83
| Facility | | $426.58 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $741.31
| Professional | | $245.47 | $380.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $588.84 / $1,071.52
| Professional | | $263.03 | $588.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $537.03 / $1,047.13
| Professional | | $239.88 | $537.03 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $616.60 / $7,413.10
| Facility | | $302.00 | $616.60 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $691.83 / $2,754.23
| Professional | | $363.08 | $691.83 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $676.08 / $1,000.00
| Professional | | $549.54 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $676.08 / $1,000.00
| Professional | | $389.05 | $676.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $741.31 / $977.24
| Professional | | $5.01 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,585.78 / $11,748.98
| Facility | | $4,168.69 | $7,585.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $812.83
| Professional | | $263.03 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $831.76
| Professional | | $489.78 | $575.44 | $831.76 |