- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $5,888.44
| Facility | | $239.88 | $346.74 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $251.19
| Professional | | $229.09 | $229.09 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $512.86
| Facility | | $288.40 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $295.12
| Professional | | $229.09 | $229.09 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $602.56
| Facility | | $281.84 | $346.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $295.12 / $467.74
| Professional | | $229.09 | $295.12 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $229.09 / $331.13
| Facility | | $199.53 | $229.09 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $501.19
| Professional | | $245.47 | $457.09 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $331.13
| Facility | | $229.09 | $229.09 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $251.19 / $9,549.93
| Professional | | $229.09 | $251.19 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $85.11
| Professional | | $50.12 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $223.87 / $234.42
| Facility | | $208.93 | $223.87 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $389.05
| Professional | | $177.83 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $691.83
| Professional | | $229.09 | $363.08 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $1,148.15
| Facility | | $229.09 | $331.13 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $9,549.93
| Professional | | $229.09 | $380.19 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $380.19
| Professional | | $190.55 | $275.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $512.86
| Facility | | $223.87 | $223.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $263.03
| Professional | | $213.80 | $229.09 | $263.03 |