- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,754.23 / $5,248.07
| Facility | | $446.68 | $2,754.23 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $1,318.26
| Professional | | $338.84 | $524.81 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,884.03 / $28,840.32
| Facility | | $870.96 | $2,884.03 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $1,659.59
| Professional | | $389.05 | $616.60 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $1,000.00
| Facility | | $436.52 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $1,174.90
| Professional | | $416.87 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $645.65 / $1,318.26
| Professional | | $371.54 | $645.65 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $3,467.37
| Facility | | $354.81 | $512.86 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $741.31 / $954.99
| Professional | | $616.60 | $741.31 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,630.78 / $8,511.38
| Facility | | $1,778.28 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $724.44 / $1,412.54
| Professional | | $426.58 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,019.95 / $4,466.84
| Facility | | $1,174.90 | $3,019.95 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $933.25
| Professional | | $489.78 | $489.78 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,884.03 / $28,840.32
| Facility | | $870.96 | $2,884.03 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $1,659.59
| Professional | | $389.05 | $616.60 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,548.13 / $8,511.38
| Facility | | $1,445.44 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,445.44
| Professional | | $398.11 | $676.08 | $1,445.44 |