- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,000.00 / $1,096.48
| Facility | | $954.99 | $1,000.00 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $676.08 / $1,096.48
| Professional | | $549.54 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $1,445.44
| Facility | | $724.44 | $724.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,513.56 / $1,862.09
| Professional | | $724.44 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,318.26 / $1,584.89
| Professional | | $1,230.27 | $1,318.26 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,698.24 / $6,025.60
| Facility | | $891.25 | $1,698.24 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $870.96 / $2,137.96
| Professional | | $602.56 | $870.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,479.11 / $1,778.28
| Professional | | $1,412.54 | $1,479.11 | $1,778.28 |
- 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
- $1,318.26 / $2,137.96 / $2,137.96
| Professional | | $1,318.26 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,318.26 / $3,090.30
| Facility | | $575.44 | $1,318.26 | $3,090.30 |
- 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 |