- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $645.65 / $645.65
| Facility | | $467.74 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $512.86 / $741.31
| Professional | | $407.38 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- 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 / $660.69
| Facility | | $54.95 | $97.72 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $467.74 / $741.31
| Professional | | $138.04 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $1,258.93 / $1,380.38
| Facility | | $72.44 | $1,258.93 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $138.04 / $1,380.38
| Professional | | $72.44 | $138.04 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $549.54 / $1,819.70
| Facility | | $74.13 | $549.54 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $467.74 / $1,819.70
| Professional | | $79.43 | $467.74 | $1,819.70 |
- 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 / $489.78 / $776.25
| Facility | | $53.70 | $489.78 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $524.81 / $933.25
| Professional | | $489.78 | $524.81 | $933.25 |