- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $426.58 / $512.86
| Facility | | $288.40 | $426.58 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $616.60
| Professional | | $158.49 | $251.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $549.54
| Professional | | $295.12 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $478.63
| Professional | | $380.19 | $446.68 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $489.78
| Facility | | $245.47 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $602.56
| Professional | | $288.40 | $380.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $295.12 / $389.05
| Facility | | $81.28 | $295.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $295.12
| Professional | | $57.54 | $83.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $831.76
| Facility | | $245.47 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $549.54
| Professional | | $288.40 | $407.38 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,258.93 / $1,659.59
| Facility | | $1,047.13 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $562.34
| Professional | | $389.05 | $467.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,513.56 / $1,949.84
| Facility | | $1,202.26 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $602.56
| Professional | | $181.97 | $181.97 | $602.56 |