- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $812.83 / $8,709.64
| Facility | | $660.69 | $812.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $616.60 / $1,174.90
| Professional | | $524.81 | $616.60 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $478.63
| Professional | | $416.87 | $416.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,905.46 / $3,090.30
| Facility | | $776.25 | $1,905.46 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $741.31
| Professional | | $478.63 | $602.56 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Facility | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $794.33 / $1,023.29
| Professional | | $407.38 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $144.54 / $724.44
| Professional | | $32.36 | $144.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $691.83 / $954.99
| Facility | | $575.44 | $691.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $794.33 / $1,000.00
| Professional | | $446.68 | $794.33 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,398.83 / $2,884.03
| Facility | | $416.87 | $2,398.83 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $794.33 / $1,047.13
| Professional | | $602.56 | $794.33 | $1,047.13 |