- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $501.19 / $501.19
| Facility | | $457.09 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $724.44
| Professional | | $398.11 | $524.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $194.98
| Facility | | $61.66 | $77.62 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $602.56 / $2,238.72
| Professional | | $562.34 | $602.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $165.96 / $309.03
| Facility | | $95.50 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $891.25 / $1,202.26
| Professional | | $851.14 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $676.08
| Facility | | $562.34 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $691.83
| Professional | | $478.63 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $831.76 / $1,096.48
| Professional | | $398.11 | $831.76 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $5,128.61 / $5,128.61
| Facility | | $1,071.52 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $1,174.90
| Professional | | $93.33 | $93.33 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $562.34 / $1,071.52
| Facility | | $74.13 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $691.83
| Professional | | $478.63 | $478.63 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $380.19 / $676.08
| Facility | | $39.81 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $1,071.52
| Professional | | $457.09 | $549.54 | $1,071.52 |