- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $794.33
| Facility | | $426.58 | $501.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $575.44 / $645.65
| Professional | | $251.19 | $575.44 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $645.65 / $14,791.08
| Facility | | $190.55 | $645.65 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $478.63
| Professional | | $295.12 | $354.81 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $295.12 / $1,230.27
| Facility | | $138.04 | $295.12 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $416.87 / $3,467.37
| Professional | | $199.53 | $416.87 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $213.80
| Professional | | $32.36 | $33.11 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $389.05
| Facility | | $245.47 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $616.60
| Professional | | $199.53 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,348.96 / $1,348.96
| Facility | | $724.44 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,467.37 / $3,467.37
| Professional | | $1,819.70 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $575.44 / $7,244.36
| Facility | | $75.86 | $575.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $933.25
| Professional | | $173.78 | $263.03 | $933.25 |