- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $4,897.79 / $8,317.64
| Facility | | $549.54 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $1,348.96
| Professional | | $457.09 | $537.03 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $741.31 / $1,258.93
| Professional | | $489.78 | $741.31 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $741.31 / $6,760.83
| Professional | | $575.44 | $741.31 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $1,096.48
| Professional | | $489.78 | $660.69 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $602.56 / $707.95
| Professional | | $467.74 | $602.56 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,148.15
| Professional | | $724.44 | $912.01 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $1,000.00
| Facility | | $489.78 | $660.69 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $7,413.10
| Facility | | $489.78 | $660.69 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $7,413.10
| Professional | | $489.78 | $660.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $8,128.31 / $16,982.44
| Facility | | $5,128.61 | $8,128.31 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $1,000.00
| Professional | | $389.05 | $616.60 | $1,000.00 |