- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,000.00 / $1,122.02
| Facility | | $870.96 | $1,000.00 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $676.08 / $1,000.00
| Professional | | $478.63 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $1,445.44
| Facility | | $870.96 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,584.89 / $1,949.84
| Professional | | $870.96 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,318.26 / $1,412.54
| Professional | | $1,148.15 | $1,318.26 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,659.59 / $5,623.41
| Facility | | $891.25 | $1,659.59 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $2,187.76
| Professional | | $602.56 | $831.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,479.11 / $1,698.24
| Professional | | $1,412.54 | $1,479.11 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,187.76 / $2,187.76
| Professional | | $1,230.27 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,318.26 / $2,884.03
| Facility | | $537.03 | $1,318.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $691.83 / $1,230.27
| Professional | | $602.56 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,258.93 / $1,258.93
| Professional | | $1,000.00 | $1,258.93 | $1,258.93 |