- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $954.99 / $1,258.93
| Facility | | $616.60 | $954.99 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $776.25 / $2,041.74
| Professional | | $363.08 | $776.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $912.01 / $1,148.15
| Professional | | $602.56 | $912.01 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,348.96
| Professional | | $588.84 | $912.01 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $977.24 / $1,548.82
| Professional | | $537.03 | $977.24 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $851.14 / $1,258.93
| Facility | | $478.63 | $851.14 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $912.01 / $1,288.25
| Professional | | $512.86 | $912.01 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $218.78
| Professional | | $32.36 | $33.11 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $912.01 / $1,071.52
| Facility | | $524.81 | $912.01 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $776.25
| Facility | | $758.58 | $758.58 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,412.54
| Professional | | $588.84 | $912.01 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,318.26
| Professional | | $588.84 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $3,630.78
| Facility | | $426.58 | $426.58 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $660.69 / $1,348.96
| Professional | | $457.09 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $812.83
| Professional | | $407.38 | $630.96 | $812.83 |