- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,174.90 / $1,905.46
| Facility | | $489.78 | $1,174.90 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $524.81 / $977.24
| Professional | | $154.88 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $1,778.28
| Facility | | $676.08 | $676.08 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $912.01
| Professional | | $112.20 | $112.20 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $676.08 / $676.08
| Facility | | $407.38 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $1,513.56
| Professional | | $676.08 | $676.08 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,445.44 / $1,737.80
| Facility | | $660.69 | $1,445.44 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $977.24 / $3,235.94
| Professional | | $416.87 | $977.24 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $676.08 / $1,513.56
| Facility | | $223.87 | $676.08 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $1,288.25
| Professional | | $478.63 | $602.56 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $645.65 / $1,202.26
| Professional | | $251.19 | $645.65 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,288.25 / $50,118.72
| Facility | | $870.96 | $1,288.25 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $602.56 / $851.14
| Facility | | $281.84 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $398.11 / $1,096.48
| Professional | | $117.49 | $398.11 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $575.44 / $724.44
| Facility | | $213.80 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $645.65 / $1,348.96
| Professional | | $251.19 | $645.65 | $1,348.96 |