- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $794.33
| Facility | | $676.08 | $676.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $575.44 / $954.99
| Professional | | $436.52 | $575.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,202.26
| Facility | | $602.56 | $602.56 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,258.93 / $1,584.89
| Professional | | $602.56 | $1,258.93 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,071.52 / $1,122.02
| Professional | | $933.25 | $1,071.52 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,288.25 / $5,011.87
| Facility | | $537.03 | $1,288.25 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $616.60 / $1,819.70
| Professional | | $436.52 | $616.60 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,230.27 / $1,479.11
| Professional | | $1,174.90 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,819.70 / $1,819.70
| Professional | | $1,122.02 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,445.44 / $2,344.23
| Professional | | $1,096.48 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,096.48 / $2,570.40
| Facility | | $371.54 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $1,023.29
| Professional | | $407.38 | $537.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,023.29 / $1,023.29
| Professional | | $812.83 | $1,023.29 | $1,023.29 |