- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $741.31 / $741.31
| Facility | | $128.82 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $851.14
| Professional | | $741.31 | $741.31 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $4,265.80
| Facility | | $707.95 | $831.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $794.33 / $831.76
| Professional | | $776.25 | $794.33 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $229.09
| Facility | | $144.54 | $208.93 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $977.24 / $1,445.44
| Professional | | $125.89 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,230.27 / $1,621.81
| Facility | | $812.83 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,230.27
| Professional | | $812.83 | $812.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,096.48 / $1,445.44
| Professional | | $933.25 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $309.03
| Facility | | $169.82 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,445.44 / $2,041.74
| Professional | | $1,096.48 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $1,148.15 / $2,454.71
| Facility | | $102.33 | $1,148.15 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $141.25 / $933.25
| Professional | | $125.89 | $141.25 | $933.25 |