- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $758.58 / $1,202.26
| Facility | | $398.11 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $933.25
| Professional | | $288.40 | $380.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $1,047.13
| Facility | | $398.11 | $398.11 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $870.96
| Professional | | $199.53 | $199.53 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $398.11
| Facility | | $239.88 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $398.11
| Professional | | $295.12 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $851.14 / $1,445.44
| Facility | | $389.05 | $851.14 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $562.34 / $1,949.84
| Professional | | $269.15 | $562.34 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $467.74 / $1,096.48
| Facility | | $229.09 | $467.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $758.58
| Professional | | $281.84 | $354.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $724.44
| Professional | | $338.84 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $1,949.84
| Facility | | $1,148.15 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $758.58 / $50,118.72
| Facility | | $478.63 | $758.58 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $512.86
| Professional | | $398.11 | $398.11 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $660.69
| Facility | | $398.11 | $489.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $331.13 / $870.96
| Professional | | $169.82 | $331.13 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $891.25
| Facility | | $302.00 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $954.99
| Professional | | $338.84 | $398.11 | $954.99 |