- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $512.86
| Facility | | $199.53 | $389.05 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $398.11
| Professional | | $204.17 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $389.05 / $1,445.44
| Professional | | $251.19 | $389.05 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $812.83 / $1,288.25
| Facility | | $691.83 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $912.01 / $1,023.29
| Professional | | $380.19 | $912.01 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,659.59 / $2,290.87
| Facility | | $229.09 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $741.31
| Professional | | $489.78 | $575.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $1,023.29
| Facility | | $208.93 | $295.12 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $1,737.80
| Professional | | $302.00 | $524.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $407.38
| Professional | | $32.36 | $33.11 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $575.44
| Facility | | $426.58 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $645.65 / $2,137.96
| Professional | | $398.11 | $645.65 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $1,122.02
| Professional | | $407.38 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,737.80 / $1,737.80
| Facility | | $831.76 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,380.38 / $1,737.80
| Professional | | $407.38 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Professional | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,584.89 / $2,089.30
| Professional | | $676.08 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $588.84 / $1,412.54
| Facility | | $309.03 | $588.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $1,148.15
| Professional | | $302.00 | $501.19 | $1,148.15 |