- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $436.52 / $549.54
| Facility | | $389.05 | $436.52 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $776.25
| Professional | | $269.15 | $426.58 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $1,096.48
| Professional | | $457.09 | $562.34 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $616.60
| Professional | | $446.68 | $562.34 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $831.76
| Facility | | $467.74 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $467.74
| Professional | | $338.84 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $331.13 / $707.95
| Professional | | $213.80 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $371.54 / $457.09
| Professional | | $275.42 | $371.54 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $1,096.48
| Facility | | $269.15 | $346.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $446.68 / $537.03
| Professional | | $316.23 | $446.68 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $562.34
| Professional | | $457.09 | $457.09 | $562.34 |