- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $954.99 / $5,128.61
| Facility | | $346.74 | $954.99 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $1,122.02
| Professional | | $478.63 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,801.89 / $8,511.38
| Facility | | $2,290.87 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $537.03 / $724.44
| Professional | | $446.68 | $537.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $645.65 / $831.76
| Facility | | $467.74 | $645.65 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $645.65 / $794.33
| Professional | | $436.52 | $645.65 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $870.96 / $1,862.09
| Facility | | $630.96 | $870.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 54 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $3,311.31
| Professional | | $524.81 | $776.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,445.44 / $3,311.31
| Facility | | $416.87 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $1,023.29
| Professional | | $436.52 | $630.96 | $1,023.29 |