- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $1,023.29
| Facility | | $245.47 | $331.13 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $245.47 / $380.19
| Professional | | $204.17 | $245.47 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $691.83 / $977.24
| Facility | | $676.08 | $691.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $549.54
| Professional | | $263.03 | $309.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $676.08 / $1,412.54
| Facility | | $234.42 | $676.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $467.74
| Professional | | $144.54 | $154.88 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $446.68
| Facility | | $245.47 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $323.59
| Professional | | $309.03 | $309.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $363.08 / $371.54
| Facility | | $186.21 | $363.08 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $354.81
| Professional | | $128.82 | $186.21 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $2,290.87
| Professional | | $1,548.82 | $1,548.82 | $2,290.87 |