- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $436.52 / $1,479.11
| Facility | | $426.58 | $436.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $407.38 / $549.54
| Professional | | $338.84 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $1,479.11
| Professional | | $407.38 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,258.93 / $1,995.26
| Facility | | $1,071.52 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,000.00 / $1,288.25
| Professional | | $489.78 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $758.58
| Facility | | $371.54 | $436.52 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $1,122.02
| Professional | | $707.95 | $831.76 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $741.31
| Facility | | $371.54 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $933.25 / $10,000.00
| Professional | | $467.74 | $933.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $1,047.13
| Professional | | $302.00 | $501.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $870.96 / $1,348.96
| Professional | | $512.86 | $870.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $2,511.89
| Facility | | $912.01 | $912.01 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,258.93 / $10,000.00
| Professional | | $467.74 | $1,258.93 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $501.19
| Professional | | $489.78 | $489.78 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,584.89 / $2,089.30
| Professional | | $851.14 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $954.99 / $1,905.46
| Professional | | $416.87 | $954.99 | $1,905.46 |