- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $724.44 / $4,677.35
| Facility | | $467.74 | $724.44 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $478.63 / $1,023.29
| Professional | | $363.08 | $478.63 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $676.08 / $1,318.26
| Facility | | $524.81 | $676.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $912.01 / $1,258.93
| Professional | | $602.56 | $912.01 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,148.15
| Facility | | $524.81 | $691.83 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $776.25 / $1,348.96
| Professional | | $389.05 | $776.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $812.83 / $1,148.15
| Facility | | $416.87 | $812.83 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $831.76 / $1,174.90
| Professional | | $478.63 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $537.03 / $851.14
| Facility | | $275.42 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $316.23 / $562.34
| Professional | | $186.21 | $316.23 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $588.84
| Facility | | $575.44 | $575.44 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $851.14 / $1,202.26
| Professional | | $575.44 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,318.26
| Facility | | $446.68 | $676.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $891.25 / $1,202.26
| Professional | | $602.56 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $707.95 / $1,348.96
| Facility | | $213.80 | $707.95 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $1,258.93
| Professional | | $389.05 | $537.03 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $457.09 / $851.14
| Professional | | $446.68 | $457.09 | $851.14 |