- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $467.74
| Facility | | $199.53 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $245.47 / $416.87
| Professional | | $177.83 | $245.47 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $346.74 / $1,230.27
| Professional | | $223.87 | $346.74 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $1,148.15
| Facility | | $616.60 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $812.83 / $912.01
| Professional | | $346.74 | $812.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,380.38 / $1,905.46
| Facility | | $218.78 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $512.86 / $630.96
| Professional | | $446.68 | $512.86 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $1,023.29
| Facility | | $204.17 | $263.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $1,513.56
| Professional | | $245.47 | $467.74 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $338.84
| Professional | | $32.36 | $33.11 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $512.86
| Facility | | $363.08 | $363.08 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $2,137.96
| Professional | | $338.84 | $575.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $977.24
| Professional | | $354.81 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,513.56 / $1,513.56
| Facility | | $831.76 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,174.90 / $1,513.56
| Professional | | $363.08 | $1,174.90 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,412.54 / $1,778.28
| Professional | | $575.44 | $1,412.54 | $1,778.28 |
- 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
- $245.47 / $436.52 / $1,023.29
| Professional | | $245.47 | $436.52 | $1,023.29 |