- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,511.89 / $3,311.31
| Facility | | $1,000.00 | $2,511.89 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,000.00 / $1,584.89
| Professional | | $870.96 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $6,918.31 / $8,317.64
| Facility | | $5,370.32 | $6,918.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $741.31
| Professional | | $426.58 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,122.02 / $1,258.93
| Professional | | $1,023.29 | $1,122.02 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $3,311.31 / $6,918.31
| Facility | | $1,348.96 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,479.11 / $1,862.09
| Professional | | $1,348.96 | $1,479.11 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,348.96 / $2,290.87
| Facility | | $1,000.00 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $2,818.38
| Professional | | $870.96 | $870.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,548.82 / $2,754.23
| Facility | | $933.25 | $1,548.82 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,548.82 / $3,019.95
| Professional | | $933.25 | $1,548.82 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,348.96 / $1,621.81
| Facility | | $794.33 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $1,479.11
| Professional | | $562.34 | $660.69 | $1,479.11 |