- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $831.76 / $1,621.81
| Facility | | $323.59 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $371.54 / $562.34
| Professional | | $302.00 | $371.54 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $1,862.09
| Facility | | $436.52 | $436.52 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $302.00
| Professional | | $173.78 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $1,096.48
| Professional | | $346.74 | $524.81 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $851.14 / $1,995.26
| Facility | | $281.84 | $851.14 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $724.44
| Professional | | $213.80 | $263.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $478.63 / $602.56
| Professional | | $436.52 | $478.63 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $407.38 / $741.31
| Facility | | $346.74 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $407.38 / $912.01
| Professional | | $109.65 | $407.38 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $10,000.00
| Facility | | $389.05 | $616.60 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $10,000.00
| Professional | | $389.05 | $616.60 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $524.81
| Facility | | $263.03 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $478.63
| Professional | | $181.97 | $218.78 | $478.63 |