- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $812.83 / $7,244.36
| Facility | | $537.03 | $812.83 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $562.34 / $1,047.13
| Professional | | $467.74 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $117.49
| Facility | | $114.82 | $114.82 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $831.76 / $1,479.11
| Professional | | $537.03 | $831.76 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,513.56
| Facility | | $524.81 | $524.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $1,174.90
| Professional | | $512.86 | $691.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,258.93
| Professional | | $812.83 | $812.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $645.65 / $1,000.00
| Facility | | $489.78 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $812.83 / $1,148.15
| Professional | | $724.44 | $812.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $1,995.26
| Facility | | $363.08 | $851.14 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $1,023.29
| Professional | | $416.87 | $549.54 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $28,840.32
| Facility | | $4,897.79 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,786.30
| Professional | | $4,073.80 | $4,073.80 | $4,786.30 |