- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $977.24 / $18,620.87
| Facility | | $467.74 | $977.24 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $371.54 / $1,380.38
| Professional | | $245.47 | $371.54 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,548.82 / $3,162.28
| Facility | | $1,202.26 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $831.76
| Professional | | $416.87 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $478.63
| Facility | | $407.38 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $870.96
| Professional | | $288.40 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $436.52 / $776.25
| Facility | | $223.87 | $436.52 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $446.68 / $758.58
| Professional | | $223.87 | $446.68 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $199.53
| Professional | | $32.36 | $33.11 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $588.84 / $616.60
| Facility | | $354.81 | $588.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $416.87
| Facility | | $407.38 | $407.38 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $758.58
| Professional | | $338.84 | $524.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,621.81 / $3,162.28
| Facility | | $1,096.48 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $831.76
| Professional | | $416.87 | $588.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,737.80 / $3,715.35
| Facility | | $346.74 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $416.87 / $758.58
| Professional | | $309.03 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $363.08 / $676.08
| Professional | | $40.74 | $363.08 | $676.08 |