- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,905.46 / $5,495.41
| Facility | | $354.81 | $1,905.46 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $4,073.80
| Professional | | $263.03 | $537.03 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $3,467.37
| Professional | | $281.84 | $281.84 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,511.89 / $5,011.87
| Facility | | $1,698.24 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $416.87
| Professional | | $275.42 | $323.59 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $398.11
| Facility | | $229.09 | $302.00 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $398.11
| Professional | | $223.87 | $309.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $457.09 / $457.09
| Facility | | $34.67 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 22 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,000.00 / $10,715.19
| Professional | | $288.40 | $1,000.00 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $2,511.89
| Professional | | $32.36 | $33.11 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,089.30 / $4,168.69
| Facility | | $524.81 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $575.44 / $3,715.35
| Professional | | $269.15 | $575.44 | $3,715.35 |