- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $234.42 / $234.42
| Facility | | $199.53 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,047.13 / $1,412.54
| Professional | | $234.42 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $562.34 / $2,041.74
| Professional | | $363.08 | $562.34 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $691.83 / $1,698.24
| Facility | | $446.68 | $691.83 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $2,454.71
| Facility | | $537.03 | $870.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $707.95 / $1,949.84
| Professional | | $407.38 | $707.95 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $70.79
| Professional | | $50.12 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $870.96 / $1,230.27
| Professional | | $501.19 | $870.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,884.03 / $2,884.03
| Facility | | $1,949.84 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,905.46 / $1,905.46
| Professional | | $1,548.82 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $416.87 / $3,235.94
| Facility | | $125.89 | $416.87 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $1,412.54
| Professional | | $407.38 | $602.56 | $1,412.54 |