- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $489.78 / $741.31
| Facility | | $457.09 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $741.31
| Professional | | $446.68 | $575.44 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $57.54 / $64.57
| Professional | | $56.23 | $57.54 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $575.44
| Facility | | $549.54 | $549.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $549.54
| Professional | | $467.74 | $467.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,786.30 / $4,786.30
| Facility | | $1,412.54 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $489.78 / $1,023.29
| Facility | | $77.62 | $489.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $741.31 / $741.31
| Professional | | $457.09 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $2,754.23
| Professional | | $48.98 | $69.18 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $501.19 / $1,023.29
| Facility | | $77.62 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $467.74 / $549.54
| Professional | | $416.87 | $467.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $389.05 / $645.65
| Facility | | $48.98 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $512.86 / $977.24
| Professional | | $398.11 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |