- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $562.34
| Facility | | $269.15 | $478.63 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $630.96
| Professional | | $173.78 | $269.15 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,122.02 / $2,238.72
| Facility | | $870.96 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $676.08
| Professional | | $281.84 | $436.52 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,096.48 / $1,905.46
| Facility | | $512.86 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $436.52 / $691.83
| Professional | | $229.09 | $436.52 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $1,737.80
| Facility | | $338.84 | $524.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $645.65
| Professional | | $338.84 | $489.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $363.08 / $416.87
| Facility | | $51.29 | $363.08 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $501.19
| Professional | | $45.71 | $70.79 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $288.40
| Facility | | $281.84 | $281.84 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $602.56
| Professional | | $288.40 | $446.68 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $2,238.72
| Facility | | $724.44 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $660.69
| Professional | | $281.84 | $436.52 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,380.38 / $2,398.83
| Facility | | $371.54 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $199.53 / $562.34
| Professional | | $154.88 | $199.53 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $501.19
| Professional | | $263.03 | $309.03 | $501.19 |