- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $3,801.89 / $10,964.78
| Facility | | $794.33 | $3,801.89 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $891.25 / $2,089.30
| Professional | | $660.69 | $891.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $812.83 / $1,148.15
| Professional | | $446.68 | $812.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,137.96 / $11,220.18
| Facility | | $933.25 | $2,137.96 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $831.76 / $1,023.29
| Professional | | $691.83 | $831.76 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $1,288.25
| Facility | | $489.78 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $912.01 / $1,548.82
| Professional | | $645.65 | $912.01 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,309.57 / $11,748.98
| Facility | | $3,548.13 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $707.95 / $1,047.13
| Professional | | $645.65 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $758.58 / $1,348.96
| Professional | | $32.36 | $758.58 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,311.31 / $6,918.31
| Facility | | $1,000.00 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $831.76 / $1,479.11
| Professional | | $588.84 | $831.76 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $707.95 / $954.99
| Professional | | $588.84 | $707.95 | $954.99 |