- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,148.15 / $3,630.78
| Facility | | $512.86 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $831.76
| Professional | | $478.63 | $602.56 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $616.60 / $2,089.30
| Facility | | $512.86 | $616.60 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $912.01 / $1,148.15
| Professional | | $794.33 | $912.01 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $1,318.26
| Facility | | $478.63 | $794.33 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $645.65 / $831.76
| Professional | | $478.63 | $645.65 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $588.84
| Professional | | $30.20 | $30.20 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $954.99
| Facility | | $478.63 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $1,479.11
| Professional | | $616.60 | $794.33 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $794.33 / $954.99
| Facility | | $331.13 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $794.33
| Professional | | $331.13 | $331.13 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $794.33
| Professional | | $194.98 | $407.38 | $794.33 |