- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,290.87 / $8,511.38
| Facility | | $457.09 | $2,290.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $1,412.54
| Professional | | $436.52 | $602.56 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $562.34 / $575.44
| Professional | | $389.05 | $562.34 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $851.14 / $1,380.38
| Professional | | $467.74 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $2,187.76
| Facility | | $602.56 | $602.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $1,148.15
| Professional | | $478.63 | $660.69 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $1,096.48
| Professional | | $794.33 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $954.99
| Facility | | $457.09 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $831.76 / $1,000.00
| Professional | | $676.08 | $831.76 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $6,606.93 / $10,715.19
| Facility | | $2,187.76 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $977.24
| Professional | | $398.11 | $549.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $7,079.46 / $7,079.46
| Facility | | $56.23 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $4,073.80
| Professional | | $3,388.44 | $3,388.44 | $4,073.80 |