- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $537.03 / $6,918.31
| Facility | | $257.04 | $537.03 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $724.44
| Professional | | $257.04 | $363.08 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $1,023.29
| Professional | | $338.84 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,445.44 / $2,570.40
| Facility | | $489.78 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $794.33
| Professional | | $295.12 | $436.52 | $794.33 |
- 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
- $263.03 / $389.05 / $630.96
| Facility | | $263.03 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $933.25
| Professional | | $275.42 | $275.42 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $323.59 / $323.59
| Professional | | $309.03 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,570.40 / $6,309.57
| Facility | | $416.87 | $2,570.40 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $354.81 / $616.60
| Professional | | $251.19 | $354.81 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $28,840.32
| Facility | | $8,317.64 | $8,317.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $3,019.95
| Professional | | $2,630.27 | $2,630.27 | $3,019.95 |