- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $2,511.89
| Facility | | $537.03 | $758.58 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $1,412.54
| Professional | | $457.09 | $588.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $1,380.38
| Professional | | $407.38 | $537.03 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $426.58
| Facility | | $331.13 | $331.13 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $758.58
| Professional | | $331.13 | $426.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $1,819.70
| Facility | | $616.60 | $851.14 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $812.83 / $2,290.87
| Professional | | $489.78 | $812.83 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $1,023.29
| Facility | | $251.19 | $338.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $794.33 / $1,202.26
| Professional | | $575.44 | $794.33 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $562.34 / $1,122.02
| Professional | | $407.38 | $562.34 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $812.83 / $53,703.18
| Facility | | $457.09 | $812.83 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $741.31 / $1,230.27
| Professional | | $616.60 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,288.25 / $2,570.40
| Facility | | $851.14 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $691.83 / $1,513.56
| Professional | | $407.38 | $691.83 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $446.68 / $851.14
| Facility | | $371.54 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $1,412.54
| Professional | | $398.11 | $588.84 | $1,412.54 |