- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,288.25 / $1,288.25
| Facility | | $199.53 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,288.25 / $1,949.84
| Professional | | $1,000.00 | $1,288.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $977.24 / $3,715.35
| Professional | | $630.96 | $977.24 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $6,456.54 / $10,232.93
| Facility | | $5,495.41 | $6,456.54 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $7,079.46 / $8,128.31
| Professional | | $1,258.93 | $7,079.46 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $11,220.18 / $15,135.61
| Facility | | $1,288.25 | $11,220.18 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $1,548.82
| Professional | | $213.80 | $213.80 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $1,288.25 / $4,786.30
| Facility | | $89.13 | $1,288.25 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,897.79 / $9,772.37
| Professional | | $2,818.38 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $70.79 / $2,089.30
| Professional | | $32.36 | $70.79 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,621.81 / $2,238.72
| Professional | | $190.55 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $6,918.31 / $6,918.31
| Facility | | $4,073.80 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,388.44 / $4,265.80
| Professional | | $954.99 | $3,388.44 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Professional | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $12,302.69 / $15,488.17
| Professional | | $11,220.18 | $12,302.69 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $4,073.80 / $5,370.32
| Facility | | $1,174.90 | $4,073.80 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,897.79 / $11,220.18
| Professional | | $2,344.23 | $4,897.79 | $11,220.18 |