- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $831.76 / $4,365.16
| Facility | | $436.52 | $831.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $501.19 / $1,071.52
| Professional | | $436.52 | $501.19 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $1,513.56
| Facility | | $588.84 | $588.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $1,318.26
| Professional | | $288.40 | $288.40 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $588.84 / $588.84
| Facility | | $354.81 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $2,187.76
| Professional | | $588.84 | $588.84 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,258.93 / $2,818.38
| Facility | | $575.44 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $831.76 / $2,818.38
| Professional | | $398.11 | $831.76 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $954.99 / $2,238.72
| Facility | | $588.84 | $954.99 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $407.38 / $1,122.02
| Professional | | $295.12 | $407.38 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $562.34 / $891.25
| Professional | | $467.74 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $50,118.72
| Facility | | $758.58 | $1,096.48 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $741.31
| Professional | | $588.84 | $588.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $707.95 / $954.99
| Facility | | $436.52 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $912.01
| Professional | | $245.47 | $416.87 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $616.60 / $1,071.52
| Facility | | $446.68 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $1,148.15
| Professional | | $489.78 | $588.84 | $1,148.15 |