- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,148.15 / $8,317.64
| Facility | | $389.05 | $1,148.15 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $933.25
| Professional | | $338.84 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $602.56 / $1,348.96
| Professional | | $416.87 | $602.56 | $1,348.96 |
- 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
- $380.19 / $562.34 / $1,000.00
| Professional | | $380.19 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $1,122.02
| Professional | | $660.69 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $870.96
| Facility | | $354.81 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,071.52
| Professional | | $724.44 | $912.01 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,548.13 / $6,760.83
| Facility | | $1,445.44 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $870.96
| Professional | | $316.23 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $45,708.82
| Facility | | $7,079.46 | $7,079.46 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,981.07
| Professional | | $3,467.37 | $3,467.37 | $3,981.07 |