- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,202.26
| Facility | | $478.63 | $741.31 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $776.25
| Professional | | $158.49 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $309.03 / $331.13
| Professional | | $257.04 | $309.03 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $1,096.48
| Facility | | $380.19 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $309.03 / $323.59
| Professional | | $288.40 | $309.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $389.05 / $489.78
| Professional | | $239.88 | $389.05 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $302.00 / $776.25
| Facility | | $158.49 | $302.00 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $457.09
| Professional | | $186.21 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $363.08 / $575.44
| Professional | | $323.59 | $363.08 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $416.87
| Professional | | $380.19 | $380.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $316.23 / $426.58
| Professional | | $186.21 | $316.23 | $426.58 |