- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $549.54 / $1,096.48
| Facility | | $309.03 | $549.54 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $524.81
| Professional | | $208.93 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $1,122.02
| Facility | | $323.59 | $323.59 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $549.54
| Professional | | $128.82 | $199.53 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $467.74 / $831.76
| Facility | | $446.68 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $354.81
| Professional | | $223.87 | $323.59 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $602.56 / $776.25
| Facility | | $331.13 | $602.56 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $457.09
| Professional | | $144.54 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $1,513.56
| Facility | | $275.42 | $380.19 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $1,584.89
| Professional | | $134.90 | $190.55 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $323.59 / $380.19
| Facility | | $134.90 | $323.59 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $426.58
| Professional | | $134.90 | $190.55 | $426.58 |