- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $707.95
| Professional | | $354.81 | $398.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,348.96
| Facility | | $812.83 | $812.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $758.58 / $912.01
| Professional | | $724.44 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,862.09 / $3,981.07
| Facility | | $707.95 | $1,862.09 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,174.90 / $1,548.82
| Professional | | $602.56 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $660.69 / $1,000.00
| Facility | | $398.11 | $660.69 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,096.48
| Professional | | $724.44 | $912.01 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $4,073.80
| Facility | | $398.11 | $794.33 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $954.99
| Professional | | $371.54 | $524.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $537.03
| Professional | | $54.95 | $70.79 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,584.89
| Professional | | $575.44 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,258.93 / $2,511.89
| Professional | | $812.83 | $1,258.93 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,621.81 / $4,073.80
| Facility | | $707.95 | $1,621.81 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,000.00 / $4,677.35
| Professional | | $602.56 | $1,000.00 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $812.83
| Facility | | $467.74 | $588.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $660.69
| Professional | | $331.13 | $416.87 | $660.69 |