- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,047.13 / $1,819.70
| Facility | | $489.78 | $1,047.13 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $1,096.48
| Professional | | $323.59 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,548.82
| Facility | | $602.56 | $602.56 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $1,174.90
| Professional | | $239.88 | $239.88 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $602.56
| Facility | | $363.08 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $602.56
| Professional | | $436.52 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,288.25 / $2,137.96
| Facility | | $588.84 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $741.31 / $2,884.03
| Professional | | $363.08 | $741.31 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $724.44 / $1,659.59
| Facility | | $436.52 | $724.44 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $537.03 / $1,148.15
| Professional | | $416.87 | $537.03 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $588.84 / $1,071.52
| Professional | | $478.63 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,122.02 / $50,118.72
| Facility | | $776.25 | $1,122.02 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $616.60
| Professional | | $602.56 | $602.56 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $602.56 / $758.58
| Facility | | $537.03 | $602.56 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $1,258.93
| Professional | | $251.19 | $416.87 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $776.25
| Facility | | $512.86 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $602.56 / $1,445.44
| Professional | | $512.86 | $602.56 | $1,445.44 |