- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $812.83
| Facility | | $416.87 | $724.44 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $1,000.00
| Professional | | $251.19 | $416.87 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,479.11 / $2,951.21
| Facility | | $1,122.02 | $1,479.11 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,023.29
| Professional | | $436.52 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,445.44 / $2,511.89
| Facility | | $691.83 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $1,023.29
| Professional | | $346.74 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $812.83 / $2,238.72
| Facility | | $501.19 | $812.83 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,023.29
| Professional | | $537.03 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $537.03 / $645.65
| Facility | | $54.95 | $537.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $812.83
| Professional | | $57.54 | $81.28 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $436.52 / $436.52
| Facility | | $426.58 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $676.08 / $870.96
| Professional | | $426.58 | $676.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,445.44 / $2,951.21
| Facility | | $954.99 | $1,445.44 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,000.00
| Professional | | $436.52 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,862.09 / $3,235.94
| Facility | | $501.19 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $891.25
| Professional | | $204.17 | $302.00 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $416.87 / $676.08
| Professional | | $354.81 | $416.87 | $676.08 |