- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $3,162.28 / $5,011.87
| Facility | | $977.24 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $275.42 / $2,344.23
| Professional | | $74.13 | $275.42 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $302.00 / $1,905.46
| Facility | | $147.91 | $302.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $309.03 / $309.03
| Professional | | $302.00 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,584.89 / $3,090.30
| Professional | | $275.42 | $1,584.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $467.74 / $2,570.40
| Facility | | $173.78 | $467.74 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $1,778.28 / $7,943.28
| Professional | | $165.96 | $1,778.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $2,398.83
| Professional | | $295.12 | $371.54 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $1,288.25
| Professional | | $199.53 | $199.53 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,288.25 / $1,995.26
| Professional | | $218.78 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $3,890.45
| Facility | | $1,995.26 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $426.58 / $2,454.71
| Professional | | $169.82 | $426.58 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $2,398.83
| Professional | | $295.12 | $354.81 | $2,398.83 |