- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,311.31 / $9,332.54
| Facility | | $602.56 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $426.58 / $870.96
| Professional | | $177.83 | $426.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $3,630.78 / $12,302.69
| Facility | | $588.84 | $3,630.78 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $501.19 / $630.96
| Professional | | $165.96 | $501.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $851.14 / $1,584.89
| Facility | | $309.03 | $851.14 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $426.58 / $1,000.00
| Professional | | $181.97 | $426.58 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,365.16 / $8,912.51
| Facility | | $2,454.71 | $4,365.16 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $436.52 / $691.83
| Professional | | $213.80 | $436.52 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $138.04 / $501.19
| Professional | | $32.36 | $138.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,090.30 / $6,760.83
| Facility | | $707.95 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $416.87 / $851.14
| Professional | | $158.49 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $288.40 / $630.96
| Professional | | $138.04 | $288.40 | $630.96 |