- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $812.83 / $2,511.89
| Facility | | $144.54 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $354.81 / $1,023.29
| Professional | | $158.49 | $354.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,584.89 / $6,165.95
| Facility | | $1,202.26 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $588.84 / $1,445.44
| Professional | | $281.84 | $588.84 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,258.93 / $1,995.26
| Facility | | $1,071.52 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $457.09 / $1,174.90
| Professional | | $190.55 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $501.19 / $3,388.44
| Facility | | $173.78 | $501.19 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $616.60 / $1,174.90
| Professional | | $316.23 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $501.19 / $1,737.80
| Facility | | $173.78 | $501.19 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $645.65 / $1,548.82
| Professional | | $371.54 | $645.65 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $549.54
| Professional | | $32.36 | $33.11 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $891.25 / $2,344.23
| Facility | | $371.54 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $1,122.02
| Professional | | $398.11 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $537.03 / $1,258.93
| Professional | | $269.15 | $537.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,258.93
| Facility | | $446.68 | $446.68 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $446.68 / $2,818.38
| Professional | | $190.55 | $446.68 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $741.31
| Professional | | $323.59 | $323.59 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $741.31 / $1,698.24
| Professional | | $407.38 | $741.31 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $2,187.76
| Facility | | $1,023.29 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $446.68 / $1,778.28
| Professional | | $91.20 | $446.68 | $1,778.28 |