- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $512.86 / $1,479.11
| Facility | | $407.38 | $512.86 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $630.96
| Professional | | $208.93 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $851.14 / $954.99
| Facility | | $537.03 | $851.14 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $363.08 / $575.44
| Professional | | $162.18 | $363.08 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $870.96
| Professional | | $363.08 | $707.95 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $331.13 / $489.78
| Facility | | $316.23 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $363.08 / $478.63
| Professional | | $316.23 | $363.08 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $660.69
| Facility | | $331.13 | $331.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $398.11
| Professional | | $331.13 | $331.13 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $954.99
| Facility | | $316.23 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $363.08 / $489.78
| Professional | | $186.21 | $363.08 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $1,348.96
| Facility | | $489.78 | $977.24 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $281.84 / $398.11
| Professional | | $257.04 | $281.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $524.81
| Facility | | $398.11 | $489.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $398.11
| Professional | | $138.04 | $138.04 | $398.11 |