- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $588.84 / $831.76
| Facility | | $245.47 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $407.38 / $588.84
| Professional | | $281.84 | $407.38 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,479.11
| Facility | | $741.31 | $741.31 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $1,258.93
| Professional | | $457.09 | $457.09 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $602.56 / $602.56
| Facility | | $562.34 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $53,703.18
| Facility | | $457.09 | $457.09 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $1,122.02
| Professional | | $331.13 | $331.13 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,230.27 / $2,818.38
| Facility | | $741.31 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $741.31 / $1,412.54
| Professional | | $457.09 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $380.19
| Facility | | $363.08 | $363.08 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $467.74
| Professional | | $363.08 | $436.52 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $50,118.72 / $75,857.76
| Facility | | $776.25 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $707.95 / $707.95
| Professional | | $478.63 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $2,089.30
| Facility | | $302.00 | $426.58 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $1,230.27
| Professional | | $275.42 | $478.63 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $436.52
| Facility | | $363.08 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $467.74
| Professional | | $363.08 | $436.52 | $467.74 |