- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $524.81 / $741.31
| Facility | | $239.88 | $524.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $524.81
| Professional | | $257.04 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $1,348.96
| Facility | | $660.69 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $416.87 / $1,047.13
| Professional | | $407.38 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $549.54 / $549.54
| Facility | | $512.86 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $53,703.18
| Facility | | $436.52 | $436.52 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $776.25
| Professional | | $316.23 | $316.23 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,096.48 / $2,570.40
| Facility | | $660.69 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $660.69 / $1,258.93
| Professional | | $416.87 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $489.78
| Facility | | $467.74 | $467.74 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $416.87 / $467.74
| Professional | | $398.11 | $416.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $50,118.72 / $75,857.76
| Facility | | $1,000.00 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $645.65 / $645.65
| Professional | | $436.52 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $1,819.70
| Facility | | $251.19 | $446.68 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $1,096.48
| Professional | | $251.19 | $436.52 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $398.11 / $489.78
| Facility | | $371.54 | $398.11 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $416.87 / $467.74
| Professional | | $398.11 | $416.87 | $467.74 |