- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $870.96 / $2,089.30
| Facility | | $457.09 | $870.96 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $645.65 / $1,584.89
| Professional | | $416.87 | $645.65 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $1,318.26
| Professional | | $371.54 | $467.74 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $794.33
| Facility | | $117.49 | $117.49 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $794.33 / $912.01
| Professional | | $117.49 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,905.46 / $2,951.21
| Facility | | $977.24 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $851.14 / $2,398.83
| Professional | | $512.86 | $851.14 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $851.14 / $2,570.40
| Facility | | $630.96 | $851.14 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,047.13 / $1,513.56
| Professional | | $758.58 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $812.83 / $1,174.90
| Professional | | $467.74 | $812.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,884.03 / $53,703.18
| Facility | | $1,000.00 | $2,884.03 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $1,445.44
| Professional | | $707.95 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,380.38 / $2,570.40
| Facility | | $1,122.02 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $812.83 / $2,041.74
| Professional | | $436.52 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $676.08
| Facility | | $426.58 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $776.25 / $1,318.26
| Professional | | $467.74 | $776.25 | $1,318.26 |