- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $616.60 / $1,148.15
| Facility | | $275.42 | $616.60 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $398.11
| Professional | | $316.23 | $316.23 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $630.96 / $1,071.52
| Facility | | $316.23 | $630.96 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $741.31
| Professional | | $446.68 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $489.78 / $741.31
| Professional | | $426.58 | $489.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $741.31 / $1,230.27
| Facility | | $436.52 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $489.78 / $489.78
| Professional | | $138.04 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $537.03
| Professional | | $269.15 | $316.23 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Professional | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $316.23 / $537.03
| Facility | | $173.78 | $316.23 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $489.78 / $741.31
| Facility | | $478.63 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $489.78 / $741.31
| Professional | | $478.63 | $489.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $676.08
| Facility | | $316.23 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $537.03
| Professional | | $331.13 | $426.58 | $537.03 |