- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $645.65 / $645.65
| Facility | | $478.63 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $707.95
| Professional | | $446.68 | $524.81 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,698.24 / $1,905.46
| Professional | | $1,445.44 | $1,698.24 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $97.72 / $512.86
| Facility | | $54.95 | $97.72 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $478.63 / $707.95
| Professional | | $147.91 | $478.63 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $1,348.96 / $1,380.38
| Facility | | $72.44 | $1,348.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $144.54 / $1,380.38
| Professional | | $72.44 | $144.54 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $478.63 / $1,737.80
| Facility | | $74.13 | $478.63 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $489.78 / $1,659.59
| Professional | | $79.43 | $489.78 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $741.31 / $812.83
| Professional | | $549.54 | $741.31 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $912.01
| Facility | | $53.70 | $75.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $691.83
| Professional | | $46.77 | $79.43 | $691.83 |