- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $891.25 / $2,754.23
| Facility | | $302.00 | $891.25 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $478.63
| Professional | | $199.53 | $316.23 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $1,698.24
| Facility | | $407.38 | $407.38 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $281.84
| Professional | | $162.18 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,071.52 / $2,187.76
| Professional | | $323.59 | $1,071.52 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $977.24 / $1,819.70
| Facility | | $407.38 | $977.24 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $562.34
| Professional | | $147.91 | $245.47 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $446.68 / $562.34
| Professional | | $407.38 | $446.68 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $1,380.38
| Facility | | $323.59 | $537.03 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $851.14 / $1,380.38
| Professional | | $263.03 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $478.63 / $10,000.00
| Facility | | $281.84 | $478.63 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $478.63 / $10,000.00
| Professional | | $281.84 | $478.63 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $407.38 / $489.78
| Facility | | $181.97 | $407.38 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $407.38
| Professional | | $125.89 | $181.97 | $407.38 |