- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $794.33 / $1,778.28
| Facility | | $407.38 | $794.33 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $602.56 / $1,445.44
| Professional | | $354.81 | $602.56 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $446.68 / $575.44
| Professional | | $416.87 | $446.68 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,630.27 / $8,912.51
| Facility | | $933.25 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $1,000.00
| Professional | | $549.54 | $851.14 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $575.44 / $831.76
| Professional | | $380.19 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $691.83 / $3,235.94
| Professional | | $436.52 | $691.83 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $537.03 / $575.44
| Professional | | $512.86 | $537.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $724.44
| Facility | | $288.40 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $812.83
| Professional | | $398.11 | $537.03 | $812.83 |