- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,659.59 / $5,011.87
| Facility | | $758.58 | $1,659.59 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $707.95 / $1,479.11
| Professional | | $457.09 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,122.02 / $1,513.56
| Facility | | $758.58 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,023.29
| Professional | | $645.65 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,621.81 / $1,949.84
| Facility | | $794.33 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $794.33 / $1,023.29
| Professional | | $380.19 | $794.33 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $2,344.23
| Facility | | $758.58 | $954.99 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $2,187.76
| Professional | | $758.58 | $954.99 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $1,513.56
| Facility | | $758.58 | $758.58 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $912.01
| Professional | | $758.58 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,202.26 / $2,344.23
| Facility | | $758.58 | $1,202.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $912.01
| Professional | | $676.08 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $1,995.26
| Facility | | $870.96 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,023.29
| Professional | | $645.65 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $912.01 / $912.01
| Facility | | $758.58 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $851.14
| Professional | | $316.23 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $758.58 / $1,380.38
| Professional | | $338.84 | $758.58 | $1,380.38 |