- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $575.44 / $17,782.79
| Facility | | $316.23 | $575.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $562.34
| Professional | | $154.88 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $1,288.25
| Facility | | $426.58 | $630.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $616.60
| Professional | | $275.42 | $436.52 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $676.08
| Professional | | $194.98 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $575.44
| Facility | | $158.49 | $281.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $302.00 / $562.34
| Professional | | $158.49 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $147.91
| Professional | | $32.36 | $33.11 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $436.52 / $489.78
| Facility | | $234.42 | $436.52 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $338.84
| Facility | | $234.42 | $316.23 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $398.11 / $602.56
| Professional | | $281.84 | $398.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,288.25
| Facility | | $426.58 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $575.44
| Professional | | $269.15 | $426.58 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $851.14 / $1,949.84
| Facility | | $229.09 | $851.14 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $562.34
| Professional | | $199.53 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $446.68
| Professional | | $234.42 | $316.23 | $446.68 |