- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $263.03 / $263.03
| Facility | | $234.42 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $549.54
| Professional | | $263.03 | $371.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $131.83
| Facility | | $41.69 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $1,621.81
| Professional | | $275.42 | $426.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $154.88
| Facility | | $67.61 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $812.83 / $1,122.02
| Professional | | $602.56 | $812.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $588.84
| Facility | | $316.23 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $323.59
| Professional | | $269.15 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $707.95
| Professional | | $588.84 | $588.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $645.65 / $831.76
| Professional | | $398.11 | $645.65 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,630.78 / $3,630.78
| Facility | | $549.54 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $660.69
| Professional | | $70.79 | $70.79 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $346.74 / $870.96
| Facility | | $66.07 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $316.23
| Professional | | $269.15 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $645.65 / $1,000.00
| Professional | | $588.84 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $199.53 / $354.81
| Facility | | $27.54 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $676.08
| Professional | | $239.88 | $302.00 | $676.08 |