- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,288.25 / $1,479.11
| Facility | | $741.31 | $1,288.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $1,258.93
| Professional | | $478.63 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $2,630.27
| Facility | | $758.58 | $758.58 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $1,348.96
| Professional | | $302.00 | $524.81 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,148.15 / $2,089.30
| Facility | | $1,122.02 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $1,348.96
| Professional | | $537.03 | $758.58 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,479.11 / $3,235.94
| Facility | | $562.34 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $416.87 / $1,096.48
| Professional | | $338.84 | $416.87 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $954.99 / $3,630.78
| Facility | | $616.60 | $954.99 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $3,801.89
| Professional | | $316.23 | $478.63 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $758.58 / $912.01
| Facility | | $338.84 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $912.01
| Professional | | $316.23 | $457.09 | $912.01 |