- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $1,949.84
| Professional | | $199.53 | $309.03 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $1,513.56
| Professional | | $245.47 | $436.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $954.99 / $1,445.44
| Facility | | $776.25 | $954.99 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $1,905.46
| Professional | | $295.12 | $501.19 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $524.81
| Facility | | $354.81 | $354.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $616.60
| Professional | | $302.00 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $616.60
| Professional | | $512.86 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $758.58
| Professional | | $380.19 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $2,630.27 / $2,630.27
| Facility | | $831.76 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $660.69
| Facility | | $208.93 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $416.87
| Professional | | $302.00 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $512.86
| Professional | | $426.58 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $186.21 / $331.13
| Facility | | $22.39 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $295.12 / $616.60
| Professional | | $223.87 | $295.12 | $616.60 |