- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,235.94 / $8,317.64
| Facility | | $602.56 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $602.56 / $1,000.00
| Professional | | $501.19 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $6,606.93 / $8,709.64
| Facility | | $3,981.07 | $6,606.93 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $954.99
| Professional | | $501.19 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $794.33 / $954.99
| Professional | | $602.56 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,071.52
| Professional | | $501.19 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $562.34 / $1,445.44
| Professional | | $467.74 | $562.34 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $812.83 / $1,230.27
| Professional | | $660.69 | $812.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $1,071.52
| Facility | | $524.81 | $724.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $724.44 / $2,951.21
| Facility | | $467.74 | $724.44 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $724.44 / $2,951.21
| Professional | | $467.74 | $724.44 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,862.09 / $3,890.45
| Facility | | $954.99 | $1,862.09 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $645.65 / $1,047.13
| Professional | | $436.52 | $645.65 | $1,047.13 |