- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $912.01 / $1,548.82
| Facility | | $512.86 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $912.01
| Professional | | $275.42 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $1,318.26
| Facility | | $512.86 | $512.86 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $977.24
| Professional | | $204.17 | $204.17 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $512.86 / $512.86
| Facility | | $302.00 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $512.86 / $512.86
| Professional | | $371.54 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,096.48 / $1,819.70
| Facility | | $501.19 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $630.96 / $2,454.71
| Professional | | $309.03 | $630.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $1,348.96
| Facility | | $331.13 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $954.99
| Professional | | $354.81 | $457.09 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $501.19 / $912.01
| Professional | | $416.87 | $501.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $954.99 / $50,118.72
| Facility | | $229.09 | $954.99 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $524.81
| Professional | | $512.86 | $512.86 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $512.86 / $630.96
| Facility | | $457.09 | $512.86 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $380.19 / $1,023.29
| Professional | | $213.80 | $380.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $436.52 / $562.34
| Facility | | $416.87 | $436.52 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $512.86 / $1,000.00
| Professional | | $416.87 | $512.86 | $1,000.00 |