- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,630.78 / $8,912.51
| Facility | | $891.25 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $2,089.30
| Professional | | $758.58 | $891.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $14,791.08 / $20,892.96
| Facility | | $8,128.31 | $14,791.08 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,000.00 / $1,445.44
| Professional | | $758.58 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $3,311.31 / $10,000.00
| Professional | | $851.14 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,621.81
| Professional | | $741.31 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $831.76 / $2,137.96
| Professional | | $691.83 | $831.76 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,288.25 / $1,819.70
| Professional | | $1,023.29 | $1,288.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $1,659.59
| Facility | | $776.25 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,071.52 / $15,135.61
| Facility | | $741.31 | $1,071.52 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,071.52 / $15,135.61
| Professional | | $741.31 | $1,071.52 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $18,197.01 / $35,481.34
| Facility | | $10,471.29 | $18,197.01 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,023.29 / $1,621.81
| Professional | | $676.08 | $1,023.29 | $1,621.81 |