- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $380.19 / $1,096.48
| Facility | | $371.54 | $380.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $371.54 / $588.84
| Professional | | $323.59 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $891.25
| Professional | | $426.58 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $489.78
| Professional | | $398.11 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $501.19
| Facility | | $288.40 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $467.74
| Professional | | $426.58 | $426.58 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $724.44 / $1,000.00
| Professional | | $537.03 | $724.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $707.95
| Professional | | $398.11 | $467.74 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $512.86 / $870.96
| Facility | | $309.03 | $512.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $575.44
| Professional | | $389.05 | $467.74 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $1,047.13
| Facility | | $389.05 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $1,047.13
| Professional | | $389.05 | $575.44 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $524.81 / $537.03
| Facility | | $269.15 | $524.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $354.81 / $562.34
| Professional | | $331.13 | $354.81 | $562.34 |