- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $933.25 / $7,585.78
| Facility | | $213.80 | $933.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $281.84 / $512.86
| Professional | | $128.82 | $281.84 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,258.93 / $1,412.54
| Facility | | $1,096.48 | $1,258.93 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $446.68 / $831.76
| Professional | | $204.17 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,000.00 / $1,659.59
| Facility | | $489.78 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $323.59 / $645.65
| Professional | | $154.88 | $323.59 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $281.84 / $512.86
| Facility | | $128.82 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $724.44
| Professional | | $288.40 | $288.40 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,398.83 / $5,623.41
| Facility | | $416.87 | $2,398.83 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $263.03 / $512.86
| Professional | | $131.83 | $263.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,011.87 / $5,011.87
| Facility | | $56.23 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,511.89
| Professional | | $2,187.76 | $2,187.76 | $2,511.89 |