- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $6,165.95 / $11,481.54
| Facility | | $1,000.00 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $537.03 / $1,348.96
| Professional | | $239.88 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $870.96
| Professional | | $537.03 | $630.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,162.28 / $6,165.95
| Facility | | $2,454.71 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $602.56 / $912.01
| Professional | | $380.19 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $1,445.44
| Professional | | $645.65 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $812.83 / $4,365.16
| Facility | | $467.74 | $812.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,023.29 / $3,715.35
| Professional | | $588.84 | $1,023.29 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,445.44
| Professional | | $724.44 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,096.48
| Professional | | $741.31 | $1,023.29 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,148.15 / $3,801.89
| Facility | | $912.01 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $741.31 / $1,174.90
| Professional | | $426.58 | $741.31 | $1,174.90 |