- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $562.34 / $691.83
| Facility | | $302.00 | $562.34 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $302.00
| Professional | | $186.21 | $218.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $691.83
| Facility | | $537.03 | $676.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $1,000.00
| Professional | | $120.23 | $120.23 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $812.83 / $1,288.25
| Facility | | $691.83 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $776.25
| Professional | | $288.40 | $380.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $691.83 / $1,949.84
| Facility | | $131.83 | $691.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $234.42 / $691.83
| Facility | | $131.83 | $234.42 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $446.68
| Professional | | $117.49 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $380.19
| Professional | | $54.95 | $85.11 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $302.00 / $389.05
| Facility | | $269.15 | $302.00 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $407.38 / $707.95
| Professional | | $186.21 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $645.65 / $870.96
| Professional | | $331.13 | $645.65 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $1,202.26
| Facility | | $501.19 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $537.03
| Professional | | $251.19 | $251.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $831.76 / $1,380.38
| Professional | | $251.19 | $831.76 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $218.78 / $302.00
| Facility | | $125.89 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $199.53 / $446.68
| Professional | | $104.71 | $199.53 | $446.68 |