- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $676.08 / $2,187.76
| Facility | | $309.03 | $676.08 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $288.40 / $602.56
| Professional | | $181.97 | $288.40 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $616.60
| Facility | | $309.03 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $407.38
| Professional | | $263.03 | $309.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $676.08 / $794.33
| Facility | | $323.59 | $676.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $323.59 / $416.87
| Professional | | $151.36 | $323.59 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $1,380.38
| Facility | | $309.03 | $389.05 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $416.87 / $954.99
| Professional | | $309.03 | $416.87 | $954.99 |
- 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
- $309.03 / $309.03 / $338.84
| Facility | | $309.03 | $309.03 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $954.99
| Facility | | $309.03 | $489.78 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $371.54
| Professional | | $275.42 | $275.42 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $812.83
| Facility | | $354.81 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $407.38
| Professional | | $263.03 | $309.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $371.54 / $371.54
| Facility | | $309.03 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $346.74
| Professional | | $128.82 | $128.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $309.03 / $549.54
| Professional | | $138.04 | $309.03 | $549.54 |