- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $912.01 / $2,187.76
| Facility | | $794.33 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $812.83 / $831.76
| Professional | | $794.33 | $812.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $1,023.29
| Professional | | $794.33 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,258.93 / $1,862.09
| Professional | | $794.33 | $1,258.93 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,479.11 / $1,995.26
| Facility | | $831.76 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $794.33 / $1,230.27
| Professional | | $588.84 | $794.33 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $831.76 / $933.25
| Facility | | $794.33 | $831.76 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $831.76 / $912.01
| Professional | | $794.33 | $831.76 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $851.14 / $1,148.15
| Facility | | $741.31 | $851.14 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $851.14 / $1,148.15
| Professional | | $741.31 | $851.14 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $707.95 / $1,258.93
| Facility | | $302.00 | $707.95 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $851.14
| Professional | | $489.78 | $794.33 | $851.14 |