- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $407.38 / $1,202.26
| Facility | | $331.13 | $407.38 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $436.52
| Professional | | $162.18 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $776.25
| Facility | | $426.58 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $288.40 / $446.68
| Professional | | $125.89 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $691.83
| Professional | | $288.40 | $575.44 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $478.63
| Facility | | $263.03 | $263.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $263.03 / $380.19
| Professional | | $239.88 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $537.03
| Facility | | $263.03 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $302.00
| Professional | | $263.03 | $263.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $776.25
| Facility | | $257.04 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $288.40 / $380.19
| Professional | | $117.49 | $288.40 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $1,096.48
| Facility | | $398.11 | $794.33 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $223.87 / $316.23
| Professional | | $208.93 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $426.58
| Facility | | $316.23 | $398.11 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $158.49 / $489.78
| Professional | | $144.54 | $158.49 | $489.78 |