- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $562.34 / $1,071.52
| Facility | | $162.18 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $363.08 / $851.14
| Professional | | $281.84 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $1,445.44
| Facility | | $416.87 | $416.87 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $741.31
| Professional | | $204.17 | $346.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $812.83 / $1,479.11
| Facility | | $794.33 | $812.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $416.87 / $954.99
| Professional | | $295.12 | $416.87 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $812.83 / $2,344.23
| Facility | | $398.11 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $724.44
| Professional | | $199.53 | $288.40 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $1,949.84
| Facility | | $354.81 | $562.34 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $338.84 / $2,089.30
| Professional | | $173.78 | $338.84 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $416.87 / $512.86
| Facility | | $208.93 | $416.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $616.60
| Professional | | $173.78 | $251.19 | $616.60 |