- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $478.63
| Facility | | $457.09 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $478.63 / $676.08
| Professional | | $426.58 | $478.63 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,047.13 / $1,047.13
| Facility | | $79.43 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $660.69
| Facility | | $562.34 | $562.34 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $562.34
| Professional | | $416.87 | $416.87 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,120.11 / $9,120.11
| Professional | | $6,025.60 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $794.33 / $1,348.96
| Facility | | $426.58 | $794.33 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $1,000.00
| Professional | | $426.58 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $562.34
| Professional | | $549.54 | $549.54 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $776.25 / $1,348.96
| Facility | | $436.52 | $776.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $562.34
| Professional | | $416.87 | $416.87 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $630.96 / $1,047.13
| Facility | | $346.74 | $630.96 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $549.54 / $645.65
| Professional | | $380.19 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,047.13 / $1,047.13
| Professional | | $549.54 | $1,047.13 | $1,047.13 |