- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $707.95 / $1,380.38
| Facility | | $281.84 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $295.12 / $446.68
| Professional | | $61.66 | $295.12 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $1,584.89
| Facility | | $371.54 | $371.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $263.03
| Professional | | $151.36 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $912.01 / $1,862.09
| Professional | | $302.00 | $912.01 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $724.44 / $1,698.24
| Facility | | $245.47 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $223.87 / $389.05
| Professional | | $45.71 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $416.87 / $524.81
| Professional | | $371.54 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $398.11 / $630.96
| Facility | | $131.83 | $398.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $794.33
| Professional | | $186.21 | $186.21 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $457.09 / $10,000.00
| Facility | | $117.49 | $457.09 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $457.09 / $10,000.00
| Professional | | $117.49 | $457.09 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $371.54 / $446.68
| Facility | | $56.23 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $158.49 / $223.87
| Professional | | $38.90 | $158.49 | $223.87 |