- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $602.56 / $1,949.84
| Facility | | $275.42 | $602.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $537.03
| Professional | | $162.18 | $257.04 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $549.54
| Facility | | $275.42 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $363.08
| Professional | | $234.42 | $275.42 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $602.56 / $707.95
| Facility | | $288.40 | $602.56 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $288.40 / $371.54
| Professional | | $131.83 | $288.40 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $1,230.27
| Facility | | $275.42 | $346.74 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $371.54 / $851.14
| Professional | | $275.42 | $371.54 | $851.14 |
- 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
- $275.42 / $275.42 / $549.54
| Facility | | $275.42 | $275.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $851.14
| Facility | | $275.42 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $331.13
| Professional | | $245.47 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $416.87 / $724.44
| Facility | | $316.23 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $363.08
| Professional | | $234.42 | $275.42 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $331.13 / $331.13
| Facility | | $275.42 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $309.03
| Professional | | $114.82 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $489.78
| Professional | | $123.03 | $275.42 | $489.78 |