- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $549.54 / $6,918.31
| Facility | | $229.09 | $549.54 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $288.40 / $575.44
| Professional | | $134.90 | $288.40 | $575.44 |
- 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
- $186.21 / $446.68 / $758.58
| Professional | | $186.21 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $870.96
| Facility | | $398.11 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $323.59 / $616.60
| Professional | | $154.88 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $794.33
| Professional | | $616.60 | $616.60 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $316.23 / $575.44
| Facility | | $141.25 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $478.63 / $660.69
| Professional | | $204.17 | $478.63 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,137.96 / $4,265.80
| Facility | | $691.83 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $524.81
| Professional | | $128.82 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $19,498.45
| Facility | | $2,754.23 | $2,754.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,570.40
| Professional | | $2,290.87 | $2,290.87 | $2,570.40 |