- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $616.60 / $1,995.26
| Facility | | $281.84 | $616.60 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $263.03 / $549.54
| Professional | | $89.13 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $562.34
| Facility | | $281.84 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $371.54
| Professional | | $239.88 | $281.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $812.83
| Facility | | $288.40 | $575.44 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $398.11
| Professional | | $141.25 | $295.12 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $870.96
| Facility | | $281.84 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $794.33
| Professional | | $281.84 | $354.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $562.34
| Facility | | $281.84 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $338.84
| Professional | | $281.84 | $281.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $870.96
| Facility | | $281.84 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $338.84
| Professional | | $251.19 | $251.19 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $416.87 / $741.31
| Facility | | $323.59 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $371.54
| Professional | | $239.88 | $281.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $338.84
| Facility | | $281.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $316.23
| Professional | | $117.49 | $117.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $281.84 / $501.19
| Professional | | $125.89 | $281.84 | $501.19 |