- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $263.03 / $933.25
| Facility | | $58.88 | $263.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $363.08
| Professional | | $194.98 | $234.42 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $891.25 / $912.01
| Facility | | $831.76 | $891.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $269.15 / $478.63
| Professional | | $131.83 | $269.15 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $645.65 / $1,348.96
| Facility | | $223.87 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $144.54 / $407.38
| Professional | | $138.04 | $144.54 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $269.15 / $446.68
| Facility | | $234.42 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $309.03
| Professional | | $295.12 | $295.12 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $363.08
| Facility | | $177.83 | $346.74 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $338.84
| Professional | | $123.03 | $177.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $2,238.72
| Professional | | $1,479.11 | $1,479.11 | $2,238.72 |