- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $275.42 / $316.23
| Facility | | $257.04 | $275.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $524.81
| Professional | | $251.19 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $616.60
| Professional | | $389.05 | $446.68 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $575.44 / $616.60
| Professional | | $457.09 | $575.44 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $1,023.29
| Facility | | $371.54 | $371.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $371.54
| Professional | | $269.15 | $269.15 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $416.87
| Facility | | $223.87 | $323.59 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $616.60
| Professional | | $269.15 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $354.81
| Professional | | $181.97 | $281.84 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $758.58
| Facility | | $213.80 | $302.00 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $295.12 / $398.11
| Professional | | $234.42 | $295.12 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $616.60
| Professional | | $281.84 | $281.84 | $616.60 |