- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $1,202.26
| Facility | | $338.84 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $436.52
| Professional | | $208.93 | $316.23 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $151.36
| Professional | | $60.26 | $114.82 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $630.96
| Facility | | $338.84 | $398.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $158.49 / $177.83
| Professional | | $144.54 | $158.49 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $446.68
| Facility | | $218.78 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $812.83 / $1,071.52
| Professional | | $724.44 | $812.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $575.44
| Facility | | $218.78 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $446.68
| Professional | | $32.36 | $58.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $316.23
| Professional | | $269.15 | $269.15 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $478.63 / $630.96
| Facility | | $147.91 | $478.63 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $128.82 / $269.15
| Professional | | $46.77 | $128.82 | $269.15 |