- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $645.65 / $18,620.87
| Facility | | $338.84 | $645.65 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $281.84 / $616.60
| Professional | | $162.18 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $707.95 / $1,445.44
| Facility | | $549.54 | $707.95 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $724.44
| Professional | | $263.03 | $436.52 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $407.38
| Facility | | $338.84 | $338.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $812.83
| Professional | | $194.98 | $389.05 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $371.54 / $741.31
| Facility | | $204.17 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $707.95
| Professional | | $199.53 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $107.15
| Professional | | $32.36 | $33.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $549.54 / $602.56
| Facility | | $309.03 | $549.54 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $416.87
| Facility | | $269.15 | $389.05 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $741.31
| Professional | | $251.19 | $416.87 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $741.31 / $1,445.44
| Facility | | $501.19 | $741.31 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $724.44
| Professional | | $257.04 | $426.58 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $954.99 / $2,137.96
| Facility | | $257.04 | $954.99 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $660.69
| Professional | | $213.80 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $354.81 / $489.78
| Professional | | $186.21 | $354.81 | $489.78 |