- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $676.08
| Facility | | $218.78 | $478.63 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $602.56
| Professional | | $257.04 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,230.27
| Facility | | $602.56 | $602.56 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $426.58 / $977.24
| Professional | | $416.87 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $501.19 / $501.19
| Facility | | $467.74 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $53,703.18
| Facility | | $389.05 | $389.05 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $691.83
| Professional | | $281.84 | $281.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,000.00 / $2,344.23
| Facility | | $602.56 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $602.56 / $1,148.15
| Professional | | $380.19 | $602.56 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $186.21
| Facility | | $177.83 | $177.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $380.19
| Professional | | $177.83 | $354.81 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $50,118.72 / $75,857.76
| Facility | | $389.05 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $588.84
| Professional | | $398.11 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $1,698.24
| Facility | | $251.19 | $446.68 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $1,000.00
| Professional | | $199.53 | $398.11 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $354.81
| Facility | | $177.83 | $316.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $380.19
| Professional | | $177.83 | $354.81 | $380.19 |