- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $562.34 / $1,288.25
| Facility | | $245.47 | $562.34 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $316.23
| Professional | | $173.78 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $1,096.48
| Facility | | $257.04 | $257.04 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $223.87
| Professional | | $125.89 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $851.14 / $1,819.70
| Professional | | $204.17 | $851.14 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $616.60 / $1,174.90
| Facility | | $407.38 | $616.60 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $537.03
| Professional | | $141.25 | $190.55 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $309.03 / $380.19
| Professional | | $257.04 | $309.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $436.52 / $630.96
| Facility | | $204.17 | $436.52 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $537.03
| Professional | | $208.93 | $208.93 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $346.74 / $10,000.00
| Facility | | $251.19 | $346.74 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $10,000.00
| Professional | | $245.47 | $346.74 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $446.68
| Facility | | $213.80 | $257.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $346.74
| Professional | | $107.15 | $154.88 | $346.74 |