- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $776.25 / $1,230.27
| Facility | | $371.54 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $398.11
| Professional | | $245.47 | $323.59 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $1,071.52
| Facility | | $407.38 | $407.38 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $616.60
| Professional | | $81.28 | $81.28 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $407.38 / $407.38
| Professional | | $302.00 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $870.96 / $1,071.52
| Facility | | $398.11 | $870.96 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $1,995.26
| Professional | | $407.38 | $602.56 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $676.08 / $1,584.89
| Facility | | $407.38 | $676.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $794.33
| Professional | | $407.38 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $724.44
| Professional | | $316.23 | $407.38 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $50,118.72
| Facility | | $537.03 | $776.25 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $467.74
| Professional | | $407.38 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $457.09 / $549.54
| Facility | | $407.38 | $457.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $562.34
| Professional | | $173.78 | $245.47 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $407.38 / $467.74
| Facility | | $346.74 | $407.38 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $977.24
| Professional | | $309.03 | $407.38 | $977.24 |