- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,513.56 / $1,737.80
| Facility | | $870.96 | $1,513.56 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $758.58 / $1,479.11
| Professional | | $562.34 | $758.58 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $3,162.28
| Facility | | $891.25 | $891.25 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $537.03 / $1,584.89
| Professional | | $58.88 | $537.03 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $2,344.23
| Facility | | $1,148.15 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,000.00
| Professional | | $630.96 | $891.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,348.96 / $2,137.96
| Facility | | $181.97 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $851.14 / $1,288.25
| Professional | | $407.38 | $851.14 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,122.02 / $4,265.80
| Facility | | $724.44 | $1,122.02 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $4,466.84
| Professional | | $380.19 | $537.03 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $891.25 / $1,071.52
| Facility | | $380.19 | $891.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $1,071.52
| Professional | | $380.19 | $537.03 | $1,071.52 |