- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,148.15
| Facility | | $1,047.13 | $1,047.13 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,288.25
| Professional | | $870.96 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,000.00 / $1,659.59
| Professional | | $269.15 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $851.14
| Professional | | $190.55 | $251.19 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,513.56 / $2,238.72
| Facility | | $812.83 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,380.38 / $2,137.96
| Professional | | $977.24 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,230.27 / $1,548.82
| Professional | | $977.24 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,174.90 / $1,995.26
| Facility | | $562.34 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,000.00 / $1,949.84
| Facility | | $234.42 | $1,000.00 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,122.02 / $2,238.72
| Professional | | $257.04 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,659.59 / $5,248.07
| Facility | | $288.40 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,174.90 / $2,754.23
| Professional | | $467.74 | $1,174.90 | $2,754.23 |