- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $707.95 / $6,606.93
| Facility | | $251.19 | $707.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $416.87 / $933.25
| Professional | | $181.97 | $416.87 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $1,000.00
| Facility | | $977.24 | $977.24 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $446.68 / $1,023.29
| Professional | | $213.80 | $446.68 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $1,288.25
| Facility | | $398.11 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $426.58 / $831.76
| Professional | | $204.17 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $1,122.02
| Professional | | $645.65 | $645.65 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $426.58 / $724.44
| Facility | | $186.21 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $741.31 / $1,000.00
| Professional | | $288.40 | $741.31 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $3,548.13 / $6,760.83
| Facility | | $1,258.93 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $354.81 / $660.69
| Professional | | $165.96 | $354.81 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $19,498.45
| Facility | | $4,168.69 | $4,168.69 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,981.07
| Professional | | $3,311.31 | $3,311.31 | $3,981.07 |