- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $724.44 / $1,778.28
| Facility | | $218.78 | $724.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $363.08 / $794.33
| Professional | | $302.00 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $758.58
| Professional | | $616.60 | $616.60 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $676.08 / $794.33
| Professional | | $151.36 | $676.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $1,000.00
| Facility | | $446.68 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $741.31
| Professional | | $363.08 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $1,000.00
| Professional | | $446.68 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $691.83 / $691.83
| Professional | | $575.44 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $6,760.83 / $19,054.61
| Facility | | $1,479.11 | $6,760.83 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $912.01 / $1,096.48
| Professional | | $812.83 | $912.01 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.36 / $691.83
| Facility | | $0.36 | $0.36 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $446.68
| Professional | | $363.08 | $363.08 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $331.13
| Professional | | $263.03 | $331.13 | $331.13 |