- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $741.31 / $1,174.90
| Facility | | $218.78 | $741.31 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $263.03 / $831.76
| Professional | | $109.65 | $263.03 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $1,548.82
| Facility | | $239.88 | $371.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $288.40 / $794.33
| Professional | | $97.72 | $288.40 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $933.25
| Facility | | $512.86 | $645.65 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $309.03 / $316.23
| Professional | | $147.91 | $309.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $257.04 / $524.81
| Facility | | $158.49 | $257.04 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $354.81 / $851.14
| Professional | | $89.13 | $354.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $912.01 / $8,511.38
| Facility | | $83.18 | $912.01 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $549.54
| Professional | | $467.74 | $467.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $691.83
| Professional | | $323.59 | $323.59 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $1,202.26
| Facility | | $389.05 | $616.60 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $1,548.82
| Facility | | $239.88 | $371.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $288.40 / $794.33
| Professional | | $97.72 | $288.40 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $467.74
| Facility | | $117.49 | $117.49 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $323.59
| Facility | | $95.50 | $190.55 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $194.98 / $616.60
| Professional | | $95.50 | $194.98 | $616.60 |