- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $954.99 / $954.99
| Facility | | $588.84 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $870.96 / $1,096.48
| Professional | | $588.84 | $870.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,318.26
| Professional | | $812.83 | $812.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $3,311.31 / $3,311.31
| Professional | | $91.20 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $851.14 / $1,513.56
| Facility | | $223.87 | $851.14 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,148.15 / $1,445.44
| Professional | | $851.14 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $758.58 / $1,412.54
| Facility | | $114.82 | $758.58 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $138.04 / $138.04
| Professional | | $63.10 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $190.55 / $2,398.83
| Facility | | $81.28 | $190.55 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $190.55 / $2,454.71
| Professional | | $81.28 | $190.55 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $2,511.89
| Facility | | $72.44 | $114.82 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $389.05
| Professional | | $66.07 | $97.72 | $389.05 |